Nick Norwitz
Appearances
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So I'll just talk in generalities about what could contribute to heart disease progression. And I think living a lifestyle that leads to insulin resistance, having overweight or obesity, prediabetes or diabetes at any point in your lifetime, smoking, obviously, various genetic factors, all could contribute to heart disease progression. So...
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You know, the boilerplate stuff, sedentary, not sleeping well, smoking, eating poorly. It's kind of boring, but the fact of the matter is those are the things that probably increase your risk for heart disease, particularly things having to do with insulin resistance.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So if you look at large-scale population studies, like having type 2 diabetes, prediabetes, high insulin resistance score, like an LPIR or a HOMIR, is a very strong predictor for poor cardiovascular health.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So I think you can kind of cluster into two possibilities. One is that there are just underlying susceptibility factors that we didn't identify in this study. So the people with plaque at baseline are probably, let's say there are like genetic factors that make one more susceptible to heart disease.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Even irrespective of LDL, ApoB, there are other factors that genetically could predispose somebody to heart disease. The people that have plaque at baseline are more likely to have those factors. So it could just be these are the folks that have other risk factors for heart disease, you know, in their genetic code, in their microbiome, in their epigenetics, whatever.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
The other possibility, which I think is more interesting, is that the plaque itself, which is kind of like an inflammatory microenvironment, could propagate, self-propagate, that plaque gets plaque, that the inflammation there locally, the activated immune cells could perpetuate more plaque growth.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So think of it as like if a seed was planted and you see the sproutling growing, it's going to keep growing. Right. Versus if the seed was never planted in the first place. You know, this study didn't answer those particular questions, but they're great questions to ask because they are the frontier of what we need to study next, because this is all about individual risk assessment.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And so, you know, trying to identify, like, why does person X have progression or person Y not? Partitioning those groups and then also looking at the outliers, like, that's where we learn so much. To double down on that point, you know, some people, they see someone with it.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
We have one person, actually not even a person in the study, but a person that's in a movie related to some of the research we're doing. You know, they're, you know, I'm about to turn 60. Their LDL is around 700. And they have no plaque on coronary CT angiography, none that can be measured. That's remarkable. That's jaw dropping. And some people may say it's just an N equals one.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So do they have plaque progression like conventional wisdom would predict? And if there is plaque progression at a population level, what actually is the major risk factor? What drives the progression? And I'll just give you the headline. There was no or minimal progression in the majority of people.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It's just an anecdote. You can say that if you want. I prefer to say this really rubs up against the status quo. Yes, at a population level, this person is an outlier. Don't you want to know why they're an outlier? Don't you want to know what makes them resistant? Because once you figure that out, that's the seed of a solution that could generalize to more people. So I love studying the outliers.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
This whole population is a population of outliers, but that's what makes them so cool to study and why we have so much to learn from them.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Obviously, the caveat here is I'm not a medical doctor, at least not for a couple months. I'm a PhD researcher, and I'm talking about my interpretation of the data. At the end of the day, talk to your physician, think about this thoroughly. But with that said, I think I can say the data is showing more and more that the best thing you can do is look for plaque.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You can get a functional test, be that a coronary artery calcium scan, a CAC, which are pretty cheap and widely available. I know I've heard places you can get them for like 75 bucks or maybe 150 bucks. And it's a pretty good risk predictor. of whether or not you'll develop plaque later on in life.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
If you want more details on the different tests available, so there's one coronary artery calcium scan that looks at calcium in the blood. Sorry, not calcium in the blood. Calcified plaques. And another one called coronary CT angiography, which looks at soft plaques as well as calcified plaques. That one's... more detailed, you could say, but a little bit more radiation.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
If you want the pros and cons of those, I'll actually direct people to a video. There's a group, Metabolic Mind. They have a YouTube channel, and I'm sure you know the cardiologist, Dr. Brett Scher, a friend of mine. He did a dedicated video on CAC versus CCTA scanning. That is great.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
He's a board-certified cardiologist, so if people want the details, I'd say you can get functional testing of your heart You can check out that video if you're actually interested in the pros and cons of the different tests. But, key point, you can look in your heart and see if you have plaque correction.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And if you're, you know, middle-aged or above and you have no plaque, that's a really good sign. If you have some, then you have a little bit less buffer room to wiggle with. In addition to that, we can talk about biomarkers. I think everybody should know some form of insulin resistance score. So there's like a lycoprotein insulin resistance score, an LPIR or a HOMA-IR.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
On a population level, there was a tiny bit of progression, something called percent atheroma volume increased by 0.8%, which is pretty modest at a population scale. And the really critical thing is in addition to most people having no or minimal progression, you had to ask what predicts progression? Is it this LDL cholesterol that we always hear about or the associated marker ApoB?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You can also just get a fasting insulin and see if it's elevated. But generally, you want low insulin resistance scores and low fasting insulin. If you have that, that's a pretty good sign. In addition to that, you can learn a lot just from a standard lipid panel. So LDL, HDL, triglycerides. Generally, you want higher HDL. They say above like 40 for men, above 50 for women and lower triglycerides.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Normals below 150, I think below 100 or even below 80 is better. It's a bit of a noisy variable. It's really important to get the test fasted. About 12 hours water only fasted is best. And that'll give you a lot of information. If you want a little bit more resolution, you can get more advanced lipid testing with, you know, LDL profiles, NMR spectroscopy.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But I would say knowing your insulin resistance score, probably a blood sugar metric like an HbA1c, some marker of inflammation, like an HSCRP and then a lipid panel, you can derive a lot from that.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And the answer was no. Actually, there was no predictive value, no association between ApoB and plaque regression or between LDL and plaque progression. LDL and ApoB did not predict plaque progression. What predicted plaque progression was whether or not somebody had plaque at baselines. So you can get functional tests of your heart.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
More or less makes sense. Yes. I mean, soft plaques can rupture and then you can get basically a local clot and that can glob off your arteries. What I would say is the literature shows that the coronary artery calcium scan is a pretty good predictor of your heart disease risk. Like if you have a CAC of zero, it's very unlikely you're going to have a heart attack in the near term.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And we can direct people to more resources on actual literature around that because it's pretty well studied that, you know, the CAC score does trump things like LZL as risk variables. The caveat that I'd lean into with respect to what you said about false sense of security is you want to interpret the results in the context of your current lifestyle and if anything changed drastically.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So I'll be more concrete with that example. If your CAC is zero and you're 50 years old and you started a ketogenic diet, you know, six months ago, after you started a ketogenic diet, your LDL went from 70 to 500. And then you get that scan. The CAC is zero. What does that actually tell you? Well, I'll tell you what it doesn't tell you.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It doesn't actually tell you much about the impact of that super high LDL on your risk profile because there just hasn't been enough time, presumably, for it to result in any change on a coronary artery calcium scan.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So that will be a circumstance where I would say somebody might have a false sense of security because they're interpreting or they could be interpreting the results of their functional scam within the context of a current marker that has changed in the near term. And the functional scans will take time to change.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So a question I think people should ask themselves if they're looking at their lipid panel and something's changed is, you know, how high is the risk marker in question? So how high is your, say, LDL or ApoB? And how long has it been there? I'll give another example because I think examples help people. My mom, she's about to turn 60. She has had high LDL her entire life.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Generally, her LDL is run between like, you know, 160, 200 plus for the majority of her life until she went keto. And she's a lean mass hyper responder. So then her LDL jumped like 400 and has been there for several years. So her lifetime exposure to LDL is high. many thousands of milligram per deciliter years. So she was trying to decide, does she want to go on any lipid-lowering medications?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
These are becoming more and more mainstream to help people individualize their risk and their treatment decisions. Something called the coronary artery calcium scan is one. And the CAC score, this functional test looking at the heart, did actually predict progression. So basically, if you had plaque to start with, you were more likely to have that plaque progress.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
There are various drugs you can take to lower your cholesterol. What she did was get a scan of her heart, a coronary CT angiography, the one that looks not just for calcified but also non-calcified plaque, and she had zero plaque. So from that, she decided, and just for context, she's an MD-PhD. She can make her own decisions. I'm not persuading her to do anything.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
She decided she wasn't going to take lipid-lowering medication. And to me, that's a sensible choice for her because she knows she's had a lot of exposure and that there's no measurable plaque. It would be different if, say, she had really low LDL her whole life, say she was 40, and then she changed her diet, and then her LDL went to 400. Then the calculus changes, right?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
If you know, for the reasons I kind of just explained, does that make sense? So how high for how long you need to interpret the functional test score, the calcium score, or the coronary CT and geography score in the context of your prior exposure and whether anything has changed.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Well, I mean, it depends like what – I mean, like because – I mean, that's all in relative terms, right? So if you said, you know, something has 10 times the calories of a stick of celery, it's not that many calories. So, you know, what x-ray? Some modern x-rays don't have a lot of radiation, let's say like the dental x-ray. So I'm not sure.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I think if you quantified it in terms of – I'm not 100% sure about this, but I think if you quantified it in terms of – like background radiation, like exposure just from living in the free world, it's something like a few months. It's not negligible. I mean, I wouldn't get one every six months. I've gotten one and I thought it was, and I have friends that have gotten a few.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
If you didn't have plaque to start with, then you were unlikely to have progression. And LDL and Applebee were pretty much irrelevant in determining or predicting whether or not plaque would progress. which is really astonishing given the levels of LDL in this population. Again, 200, 300, 400, 500 LDL. It's quite remarkable.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I don't think it's catastrophically high.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I love how you approached it. I think, you know, you got functional testing on yourself that informed your decision, and nevertheless, you went about doing a risk-benefit analysis that was right for you. You thought this medication had a low side effect profile, which I think generally it does, and also fit your physiology.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You know, the ezetimibe, as I know you know and your audience might know, it blocks cholesterol absorption at the level of the gut. So as a response, your liver increases the LDL receptors and pulls them out of the blood. More or less, it's acting locally at the intestines and then signaling to the liver.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So if the side effect profile is pretty low and the risk profile is pretty low and you're not having any symptomatic side effects, and all that's happening is a number on your lab report is going down that might reduce your risk or might not, but it might, then why not? In the risk-benefit analysis, the way I see you think through it is like, I am reassured by this functional test. Nevertheless...
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
The cost of me taking this prescription is basically nothing, and there might be benefit. So why not? It seems pretty reasonable to me.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And I just want to emphasize one more thing, and then I'll get off my monologue. The really interesting thing about this population, lean mass hypersponders, is they are the first and only human population we have ever studied that has high LDL as an isolated variable, a
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It's an interesting point. I did. There were a lot of studies actually that came out last year. I think starting with one in the New England Journal about microplastics in plaque. And it was pretty shocking. I think I did a video a while back on ways to avoid microplastics. And I was doing the research for it and it was just like the most depressing thing. They're everywhere.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
They're literally everywhere. How can you avoid it? And I think it's one of those things where... I'm not sure what the absolute risk exposure is and how we need to reevaluate what our modern risk profile might be as we age, you and me being generally younger men versus, say, our grandfathers.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I think it's something to take into consideration independently and then do your best to try to, you know, avoid. I think my impression is, yes, they're everywhere, but there is still the big like heavy hitting items you can avoid. So I don't get plastic takeout containers and microwave plastic. Do not microwave your food in plastic. Don't have plastic water bottles, things like that.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Maybe if you get some grass-fed regenerative beef, there might be a little microplastic in there. I think that's probably a lower absolute exposure than the things that people typically do. So if you carry around a water canteen and use purified, filtered water, you're not microwaving in plastics. I think that probably should bring most people a decent peace of mind.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
apart from metabolic dysfunction, because a lot of people are metabolically unhealthy in the population, and that changes the metabolic context, and apart from genetic drivers like familial hypercholesterolemia. So it's true if you have a broken lip metabolism. There are some people that are unlucky enough to be born with this.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Other than that, it's just like, what can you do in your lifestyle? For example, I live in downtown Boston. you know, next to a couple hospitals. We live there because my girlfriend works at one. She has to get up at like 4 a.m. for her surgical residency. So like it makes sense to live in a city. In the city, is the air quality that great? No. Is there probably a lot of plastic exposure?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Yes, but it's where I am in my life. So I think everybody just kind of needs to make the... reasonable decision for themselves and realize that might not be perfect. So yeah, microplastics, probably a problem. Do what you can. That's where I stand.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You want to create insulin resistance and crazy blood sugar levels and lots of stress. So I would say this person would probably be a shift worker working at night, but not just at night, like their schedule will be changing. So maybe, you know, they, you know, work, you know, the eight hour shift. So they're like constantly cycling with a change in their circadian pattern.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You know, they're probably a smoker. You know, that's definitely going to promote heart disease. Snacking on sugar. All the time. So, like, always with some M&Ms or Oreos in their pocket. This is a very high-stress lifestyle. So, you know, always worked up. Always raging at things. Probably a little social connection. Not a lot of time for de-stressing. Very little exercise.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So, they're eating 2,000 steps per day. And that's only when they're walking to the vending machine to get more Oreo cookies. Not exercising. Sleep-deprived. Smoking. Junkie diet. And, yeah... I think that'll probably manifest in heart disease pretty quickly.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Um, let's put it in the context of something that like people would realistically eat. Because of course, you'd say, oh, he's just eating Oreos for every meal. But I would say, imagine this person's going to Starbucks and they're getting a coffee, but they're getting it with like, you know, you know, multiple pumps of like syrup and sugar.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I mean, you can go to Starbucks and get some of these what like like white mocha lattes with two times or more the sugar of like a regular 12 ounce Coke, something like 79 grams of sugar. So something that, you know, might seem like, all right, it's not the healthiest, but might not be too bad, can actually be really bad.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
If you have a broken lip metabolism, you can have very high LZL and also typically have advanced heart disease at an early age. Something called homozygous familial hypercholesterolemia. Kids will get heart attacks at like, you know, age... This is different because it's not that these people have broken liver metabolisms.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So let's say they're getting a sugary frappuccino or like a mocha, you know, white chocolate latte at Starbucks with some sort of breakfast pastry. So they're loading up on the carbs and sugar, but something that people realistically eat.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And just because of the culture and, you know, maybe they work in a hospital setting and there's like donuts at the nurse's station, they pop a couple donuts at 10 a.m. For lunch, what's in the cafeteria? Let's say there's like pizza and fries. And a salad. But the salad has, you know, pretty low quality oil. Maybe it's made with like old soybean oil.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So having this like salad with pizza and maybe a chop of milk just because it's available. So a little carbon has 40 cents. So more sugar, more processed food, all of that. Maybe they have a snack later. Maybe they have an energy bar. Let's say it's a Clif Bar. Again, lots more sugar. Something that people generally eat. They think, oh, there's some protein in here.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It has micronutrients because it's been fortified. But it's just sugar on sugar on sugar. You know, they're spiking their blood sugar all the time. They're dropping their blood sugar because it's spiking. So they're probably going to be hungry again for dinner at around like six, seven or eight. So, you know, what do they get for dinner? Well, let's just get some Uber Eats. What's good?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Oh, let's get, you know, a burrito and a soda. And then they're hungry later. So, you know, YOLO, let's treat myself. It's had a stressful day. Let me have, you know, some potato chips and maybe an ice cream bar from the vending machine. And, you know, that sounds kind of, you know, actually, what I would say is the person listening should pause. How did that sound to them?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Because I actually think you're probably going to have a bifurcation of listeners. Some people are going to be like, oh my God, that's disgusting. I can't believe anybody eats like that. And then other people are going to be like, Yeah, I can see it.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So I think that's actually interesting for an interesting exercise for the listener to pause and do a reflection on what their response was as I was describing it. Because it's so interesting how we can calibrate and recalibrate to what is normal. Like when I was a teenager, that would have been like, yeah. It's a reasonable day of eating. It's not the healthiest, but, like, okay.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Now I cannot imagine eating like that. I just truly can't imagine it. Or, you know, my recalibration for sweet has totally changed. I used to be like, oh, yeah, ice cream daily. That's pretty normal. You know, if you're healthy, you know, you probably can outrun that, quote, bad diet. Just, like, a little bit of empty calories. No biggie. Now I can have, like, a few frozen cherries.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It's that in cutting out carbs, sometimes even irrespective of saturated fat intake, in cutting out carbs, there appears to be a metabolic response whereby the cholesterol trafficking, fat trafficking system gets upregulated. And as a result, an epiphenomenon, you could say the LDL goes through the roof.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And it tastes like an ice cream sundae used to. So I think the interesting part about that exercise is for people to reflect on, like, where is your baseline of expectation for what a healthy, reasonable diet is, which you can kind of test by what was your emotional reaction to me describing that unhealthy lifestyle or that unhealthy diet, so to speak.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
westernized diets I mean if you look globally at like where inflammatory bowel disease and also irritable bowel syndrome is like on the rise it's everywhere that there's you know a westernized diet so the more processed junky food we eat with the more added chemicals in the more like we are to develop gut dysfunction that shouldn't really be surprising I mean when you just think about the scale of the things that are adding to our food that we were not designed to be exposed to evolutionarily speaking
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
it's no surprise that things are getting screwed up. And the fact of the matter is the burden of proof is not on the food industry that's introducing these foods to demonstrate no long-term harm. They can show no acute toxicity, but in terms of just this scale of exposure and the inadequacy of long-term safety testing for the things that get introduced into the diet,
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It really should be no surprise that eating a more processed westernized diet contributes to an increase in, let's just say, gastrointestinal upset on the spectrum of I get some bloating to I have bloody diarrhea 20 times a day. I need to get my colon removed.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
We need to first acknowledge that this is a population that is, I would say, suboptimally served by Western medicine. That is not to say doctors aren't doing their due diligence with their patients. That is not to say some patients don't do remarkably well with surgeries or immunomodulating medications or other medications.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So this is really a complex story that I'd love to get into with you about novel corners of physiology. resulting in pretty dramatic cholesterol lipid profiles that give most cardiologists heart attack by proxy. By that, I mean it's very shocking. And then examining, well, what's the mechanism behind this? And also, what does it mean for risk?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
That is to say that there is a population of people, and I was in this group, who, despite trying all, quote, evidence-based medicine has to offer, still find themselves suffering terribly.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And if you have ever been in that sort of situation or known someone in that sort of situation, you know that desperation can lead people to try crazy things, things that aren't necessarily proven with the most rigorous research. So I think that's what's driving people to try things like a carnivore diet, which from the mainstream sounds crazy. But when you're desperate, you'll do anything.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And if you hear stories... of people saying, well, I suffered like you and I tried this thing and it worked remarkably. Then what goes through that person's mind, the person suffering is, well, what do I have to lose?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Sincerely, you could be in the ICU, you could have no social life or engagement because you just have to find a toilet every 30 minutes to crap out your ass and you're in incredible pain, you're losing weight. What do you have to lose by trying a dietary tweak? So people try things like carnivore or ketogenic diet, and then a lot of them actually have incredible responses.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So it's spreading from grassroots experimentation, word of mouth. Now, just to give a little bit more literature context, we have done a case series on people using carnivore diets for inflammatory bowel disease. I interviewed these patients, 10 patients. We did in-depth medical histories, dietary histories. We had lab reports, colonoscopy reports.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And to hear these patients' stories and look at their medical histories, I mean... The things I've seen and heard, I can't unsee and hear. To hear people say, like, I suffered with this for 20 years. Medications didn't help. Surgery didn't help. Now I'm living a life that I never thought I could have again. I feel like a new person. Why didn't somebody tell me about this earlier?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Like, that gets you really interested and curious. And there's physiological reason to think this would work. it's already actually known that fiber elimination, now talking carnivore, can be therapeutic in treatment-resistant cases of Crohn's disease. It's actually sometimes prescribed for kids with Crohn's disease who aren't responding to treatment.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
They put them on fiber-free liquid diets, and in about 60% to 85% of cases, they go into remission. This is published on. And we also know that ketones are anti-inflammatory. They help feed the gut lining cells. They reduce inflammation. And there's actually an inverse association between ketone levels and inflammatory bowel disease activity in patients.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So higher ketones, lower inflammatory bowel disease activity. So we have some data to say this makes sense. And then a... building a mountain of clinical cases saying this works. The next step is going to be to do the randomized controlled trials needed to make this mainstream. The fact of the matter is they're hard to get funded and organized.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And these new data say the risk profile might not be what we would otherwise think if we weren't studying this population.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I mean, you need millions of dollars for these studies. Big Pharma isn't paying for it. The NIH isn't giving me that money. So you need to get a little bit more creative. So the stage we're at now is getting the word out about, look, this appears to be helping people. We need more research so it can help more people.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Yes, it was the John Radcliffe Hospital and the NHS when I was at Oxford. I spent some time in a palliative care ward and ICU. And yeah, no, I was quite poorly off. I was a dangerously low weight. So malnourished that my heart rate was like dropping into the 20s. Very weak.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And I had, you know, over the course of a couple of years, gone from being like, you know, a high performing athlete and academician to being just completely broken. I mean, the psychological...
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
trauma of being like a social person who's breaking pushup records and running sub three marathons to being like, I'm in a bed, 20 something year old guy, not dating, not engaging my friends, can't even keep up with my studies, you know, wasting away physically, knowing that right now it takes me more energy to get up and go to the bathroom than running a marathon used to take and not having an answer.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Like that's where I was. So when you talk about desperation and trying something, quote, crazy, you have to understand that is the mindset that people are in when they start experimenting with these things that society still stigmatizes. And I think when you start to appreciate that, you can understand the decisions some people make with respect to their health.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So with respect to the osteoporosis, I'll get to that first. I actually do have a very weird genetic mutation, a very, very rare one. And basically the way it probably manifested is when I got to marathon running, generally when you load bones mechanically, they should respond and get stronger. Just like when you load a muscle. When you lift up heavy weights, your muscles should get stronger.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But these programs are dependent on certain genes and certain genes getting activated. And I have a mutation in one gene pathway. LRP5 went signaling. So basically when I started running more, my bones didn't get stronger fast enough. So they got weak really quickly. And that's how I developed osteoporosis. That's since improved. I just can't run anymore, but otherwise I'm perfectly healthy there.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
No longer have osteoporosis. Um, the inflammatory bowel disease, it's hard to say. I mean, I did eat a pretty standard Westernized diet, quote, balanced diet. I did a lot of fruits and vegetables, but I did eat, you know, a fair amount of junk food as a kid to normal kid growing up in the 2000s. You can imagine what I ate.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And also unique to me is I did get intravenous antibiotics very early on in life as a neonate. And we actually do know that can screw up your microbiome basically for life. So we know that early life antibiotics, you know, when you're a neonate can increase inflammatory bowel disease risk, say in your 20s by about 500%.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So I did have that insult behind me, in addition to eating a pretty standardized Western diet, and then developed ulcerative colitis at a pretty typical time, my early 20s, for a young guy. So, you know, maybe I would have developed it anyway if I didn't get the IV antibiotics, or even if I ate perfectly. I think that's unlikely.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But those were the contribution factors that led to my health issues. Now, how I found a ketogenic diet was... It just existed in the zeitgeist. And it was something that I didn't know much about. And I tried prior to having any true interest in education in it. I was just desperate. I had tried everything else.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I tried, you know, specific carbohydrate, low FODMAP, you know, paleo, Mediterranean, pescatarian, vegan, vegetarian, whatever. And eventually, I tried a ketogenic diet. And the results were that my inflammatory markers dropped to the lowest they'd been in a long, long time into the normal range. I just started feeling much, much better.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And then eventually, years later, when I got another colonoscopy, I was in biopsy-proof remission. So, you know, everything went my way. And with respect to carnivore, because my initial ketogenic diet... It did have more, it was kind of like more Mediterranean-esque spin, lots of like olive oil, you know, green vegetables, salmon, etc.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
My interest in carnivore arose as, I mean, the carnivore diet movement just arose. I'm like, this is provocative and interesting. And I like curious, provocative, interesting things. So I started to delve into it and dabble with it myself. And start to talk to people who had tried a carnivore diet.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And I thought, you know, this is a remarkable frontier of nutritional therapy that deserves further exploration. So to that extent, I've kind of become much to my, in a way, dismay, like a bulldog of the carnivore diet. Like I'm kind of like agnostic. I don't care. I'm not anti-vegetable. I'm not anti-unsaturated fat. I don't really care.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You know, I don't think oxalates are that big a deal or a lot of the things that people talk about in the carnivore diet community. But I do think... The carnivore diet deserves more study, and it's super poorly understood and stigmatized.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So you do see me standing up for it a lot of the time, writing case reports on it, doing myth-busting around it, not because I think it's the one diet for everybody, but I think because it's just an underutilized and under-researched tool that could really help people.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Oh, accurate way to think about it in general, but not for me. So the fact of the matter is, like I said, I started a ketogenic diet that was very not carnivore. And it was sufficient to put me into remission. So the factor at play in me probably has to do more with ketosis being protective. So I could eat, in theory, a plant-based diet.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
a low-carb diet and be in IBD remission, that doesn't mean my symptoms are perfect. So often people confuse inflammatory bowel disease with irritable bowel syndrome. Inflammatory bowel disease, either ulcerative colitis or Crohn's disease, is like you look in the colon and there are histological signs you have a disease pathology. We can see it. We can visibly see it if we look in your colon.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Irritable bowel syndrome is a little bit more fluffy and symptomatic. It's like, you know, constipation, diarrhea, GI upset, real symptoms that people experience, but it's not exactly clear what's causing it. And you don't necessarily see signs on histology. So you look in the colon.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And so a lot of people have irritable bowel syndrome and those symptoms matter to people have bad constipation, diarrhea, bloating, like that's unpleasant, right? So for me, if I eat lower fiber and more animal-based, gearing towards more carnivore, my GI system is just happier. And my days are happier. I don't have to spend as much time in the bathroom in the morning. It makes my life easier.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And do I know for a fact that isn't affecting my long-term health negatively in some other ways? No, I don't. I absolutely don't. And I would say all things being equal, my personal opinion would be probably more diverse diet, more fermented foods, more fiber, all things being equal, which is really important. You're probably hedging your bets on a healthier gut and healthier life overall.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I don't know that for sure. There's actually literature suggesting maybe a carnivore diet and keto diet don't do things like decrease diversity or diversity isn't even that important. Actually, as a quick aside, there was just a paper that was published about on trying to restore the microbiome of people in industrialized society.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I think with people in Canada, and they were using a non-industrialized diet designed from the diet of people in Papua New Guinea. And it was interesting. It's called the Restore Diet. People go into PubMed. I think it was in Cell Host and Microbe, one of the cell journals. But what they found was that the diet improved, you know, cardiometabolic risk factors.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It was a plant-based diet, plant-based diet, restore diet that was not industrialized, improved health. It was thought to, quote, improve the microbiome, but diversity actually went down, which is interesting because it kind of like cuts out a couple, let's say, like motifs, themes, common wisdoms. And one of them is that more microbiome diversity is better.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I don't want to myth bust that right now. Like that is such a crude marker. Just having more diversity in your microbiome doesn't mean you have a healthier microbiome. All we really know about the microbiome of, you know, what is a healthy microbiome? It's a microbiome of healthy people. So it's really complicated to study.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But that said, I would say on balance, if you can, eating more diverse whole foods with different fiber types, including plant foods, fermented foods, I'm a big fan of fermented foods, in theory, at least, probably is good for your gut health. But again, it comes down to individual choice.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So for that individual, if they're going to be happier and feel much better on a carnivore diet for whatever reason, They're probably going to do that, even if it theoretically could affect their health for the long term. And then the question becomes, can you actually change your microbiome? Can you really adapt it?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Like you said, I'm kind of behind the eight ball with these IV antibiotics I got as a neonate. I would love a protocol. I truly would love a protocol where I'm like, I can make my microbiome super healthy and resilient to all sorts of, quote, stressors. Because quite honestly... roasted Brussels sprouts with like crumbled walnuts, maybe a little bit of cranberry on it. Sounds delicious.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It sounds so good. I want to eat it. It screws with me. Or like a cauliflower mash with a ton of ghee. Delicious. But I'd be tooting like a chimney. So I don't have it. It's not that I don't think they're not healthy. It's just that it doesn't suit me. And theoretically, people think, oh, you can shift to microbiome. The protocols like are not straightforward. It's things we need to design.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I think maybe in the future we'll have protocols for fecal matter transplants. That's super cool. But it's not as easy as you just take somebody else's poo and take a pill. How do you process it? How do you prime your gut with antibiotics? Because you kind of have to throw a grenade in there to wipe things out before you repopulate the microbiome. And then how often do you have to take the sample?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Do you take it orally? Do you take it rectally? And how do you keep the sample? It's actually kind of complicated when you get down to brass tacks. I've thought about it. I've thought genuinely about having friends who I think of how healthy microbiome is donate poop samples and trying to repopulate myself. But I just have not been able to come to like, this is a protocol I feel comfortable with.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Right. So I think we're going to have to step back and go through some of the framing literature, but also make the critical point that some of the things you said that might sound at odds with what I said, like Apple being LDL being causative, are actually consistent with what I said.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
on executing. If your audience is aware of research that comes up anytime in the future, or maybe even exist that I don't know about, and they have a protocol, like a genuine protocol for an FMT they want me to test, I'll do it. I love the idea. It's just like a lot harder than you think. So for those people who are behind the eight ball with their gut health, like people do what they can.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
They just do. They do what they can to survive and feel good every day. And it's always how people are going to operate.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I don't know how my thumbnail is going to look on that one. But well, like N equals one experiments, it will be super interesting. I think. I don't want to just dose myself with harsh antibiotics for no reason.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And I think the challenge I want to present your listeners with is really grapple with the ideas and the words I'm saying and hear how these ideas are actually consistent, not conflicting, and how context is really important. Let me first actually attack that idea of LVL and Applebee being causative in heart disease, because indeed they are. And by that, I mean they're part of the causal cascade.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I would say I'm going to paraphrase from a patient quote I heard recently, which was something to the effect of anywhere you go on the Internet, you can find someone telling you that any food is bad for you. So I guess I should just not eat. Oh, but also fasting kills you as well. But don't stress about it because that'll kill you as well.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Like anywhere you go, you're going to have somebody saying something negative about some compound of the diet, be it cholesterol, saturated fat, salt, oxalates, lectins, what have you. Sometimes, actually, usually I'd say there's a grain of truth to that. So oxalates, for example, some people might have sensitivities.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Doesn't necessarily mean, though, that the whole food that has this component in it is actually bad for you. Because whole foods are complex ecosystems. And so it's not always clear what the biological result will be of having that food. And you can't reduce it down to a singular ingredient that may or may not be harmful in certain contexts and at certain doses.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
things are always more complicated than that. One of my favorite examples is sesame. The reason I like this example is because it's super high in linoleic acid, omega-6. And people think about that as inflammatory and bad for you. But the literature mostly shows that sesame and sesame products like tahini are anti-inflammatory. And so you think, oh, how can we reconcile that?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And then you realize, oh, well, the whole food is packaged with things that help, say, protect against oxidation of the fat. So these things called lignin antioxidants in the sesame. And if you actually look at the oxidation profile of sesame fat with a little like acid, it's super low compared to just say like, you know, processed industrialized seed oil.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Again, like the whole food is different than the isolated component. Let's talk oxalates. What does the literature on dark chocolate say? On balance, is it healthy for you or unhealthy for you? On balance, dark chocolate is healthy for you. It's good for heart health, good for vascular health. It's good for brain health. On balance, that's what the literature says. Is it high in oxalates as well?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Yes. So, you know, people have their different sensitivities. You're always going to find somebody in the corner of the Internet that will, I don't want to say fear monger because that cheapens it. And I don't think that's the point. But let's say be particularly sensitive to potential pitfalls of certain ingredients. And I think it's OK. to be aware of that, but take them with a grain of salt.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
On balance, my opinion is not that fiber, oxalates, leptins, plant anti-nutrients are a terror. I think most people can tolerate them just fine. I think on balance, vegetables are perfectly healthy for most people. And I say that with the context and the framing that, but I don't eat a lot of vegetables, fiber, or these foods because of my personal circumstance.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I don't think a lot of people try to take the time to separate like their narrative and what they do from maybe what the literature says. But my perspective now getting more philosophical is like what the literature says and what somebody else does that might work for them has no bearing. on my individual history and my individual narrative.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So if somebody eats a high oxalate, low fat vegan diet and does it tremendously well and is healthy and happy, that doesn't detract from the fact that I had a benefit on a ketogenic diet. It doesn't. I just want people to get to a place where they are healthy and happy. And I think just discussing the literature openly facilitates that. This is my current stance. It could change in the future.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
We had a bunch of other things we were going to talk about. We decided we actually found out this morning our paper got accepted. So we're kind of pivoting. You had a lot of enthusiasm in that opening. I hope I can deliver. But this is truly an exciting moment with this paper getting accepted because it is a first of its kind study.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But no, I don't hold those perspectives, which some people in the carnivore community might hold. And that's fine. I think it's ridiculous. Actually, I was criticized recently by somebody on Instagram who said they were upset that I was affiliating with people in the carnivore community.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So if you didn't have ApoB or LDL particles or they were at the floor, you really can't develop heart disease progression. That's true. But it's also true that context, metabolic context really matters. If two different people have the same exposure to LDL or ApoB. So the same level, how high it is for the same duration of time. Will those two people develop heart disease at the same rate?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
They said something to the effect of, why would you affiliate with these people who you don't share this perspective with? And I was so taken aback. I was like, really? Your expectations that I'd only collaborate and communicate with people who have a carbon copy of my perspective of the nutrition world? Isn't that a little dysfunctional? So we can differ on these things. I'm sharing my opinions.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
They're evidence-based insofar as I'm reading the literature. But interpreting science is subjective. These are my two cents. You're free to hear other people's few cents and come to your own conclusion.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So there was a study that just came out in Cell Metabolism on how the sweetener aspartame can cause heart disease. I did use the word cause very intentionally. And that's because this was a mechanistic study. It was looking at how aspartame can promote heart disease progression. It was done in mice and monkeys. which comes with the caveats of animal studies.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But bear in mind, you can't do this study in humans. You can't do a randomized control trial where you say, here, you people, you're going to randomize you to a three-day protocol for 30 years and then check back in. You feasibly can't do this study. So you do need to turn to animal models to delve into mechanism and see how that lines with the human population data.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And human population data do suggest that artificial sweeteners associate with cardiovascular disease. So this gives mechanistic insight.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Now, what they did in this study is use different doses of aspartame, starting in mice who were vulnerable to cardiac disease, and showed that even at low doses, equivalent of about three Diet Cokes per day, we'll get back into that in a minute because there's been controversy over the dosing, but I'm going to say three Diet Cokes per day, cause plaque progression.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And what they found was that it contributed to insulin resistance, increased insulin levels. And what that led to was an increase in an adhesion molecule, CX3CL1. The name's not really important, but basically a molecular baseball glove for circulating immune cells, which then grabs the immune cells, brings them in to the artery wall, and that promotes plaque progression.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So they showed this happened in mice, and then monkeys had a similar response, at least with respect to the insulin response to aspartame.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And it starts to build a case for, yeah, well, if we have an association between artificial sweetener intake, including aspartame and cardiovascular disease, and we have this mechanism which generalizes to primates, at least in some case, then what does this mean for cardiovascular health in humans? The data have their limitations. All studies do.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You will never have the RCT that some people are asking for. It's implausible. I present these data as food for thought so people can decide whether or not they want to have a Diet Coke. And, you know, Diet Coke being a common aspartame-containing food. And one thing I'll say is, like, you know, my perspective... is that the risk of eliminating a Diet Coke is negligible.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Zero, with respect to metabolic health. Like, if you don't have Diet Coke, nothing negative happens metabolically. It is totally a leisure item. And I also don't like the binary of people like, but is it worse than a Coke? I'm like... Probably not. But why set up that binary? People don't have a choice between just Coke and Diet Coke. You can have a water. You can have a sparkling water.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You can have a stevia sweetened beverage. So I'm not a fan of that binary. These are what the data said. And yes, people got very up in arms, very defensive. I mean, it's not really surprising. One guy did a hit piece on it that was kind of misleading, but he was being paid by the American Beverage Association. So that's not really surprising. They definitely have their tentacles everywhere.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And the answer is no. There are other factors that influence what the absolute risk or absolute progression rate is. Some person might have really rapid progression. Other person might have such minimal progression that it's basically negligible. You can think about it as kind of if you like, you're mathematically inclined, a little graph.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
At the end of the day, people make their own decisions, but those are what the data say. But I think it's socially fascinating to see how people tried to slice and undermine it. So going back to that three Diet Cokes per day thing. They don't say exactly how much fluid the mice consumed per day, but it was 0.15% aspartame. So there's different ways you can do the calculation.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
In medical news today, the New York Post were both reporting three Diet Cokes per day based on their calculations, but they didn't show their math. So I showed my math, how do I get to that number, and came to a three Diet Cokes per day dose. Now, ironically, I actually made two math errors, but they balanced each other so that I redid the math. It comes out to about three Diet Cokes per day.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Or, I mean, there's many different ways to do the math. One person was saying, oh, but you should do it based on body surface area, not adjustment for weight, because you want to adjust the mouse weight to human weight. And they came to 11 Diet Cokes per day. I'm like, okay, fine. Three, 11, it's besides the point.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And in fact, even at the lower dose of 0.5%, which would chop that 11 to a 3.66% dose, a 3.66% Diet Coke dose, there was still a biological effect. So the point here is, if you do try to dose adjust, there may be a physiologic response in humans. It's complicated by the fact that the human literature isn't really clear.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Acute feeding studies in humans of aspartame don't necessarily show insulin spikes, but the literature is a little bit murky. Chronic feeding with artificial sweeteners does show an insulin resistance response in some people and not in others. So yeah, the human data is murky. I'm not saying this is a closed and shut deal.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But the new interesting mechanistic data, I think, and people can watch my video and see if it's reasonable, should make people think twice about having a Diet Coke. And at the end of the day, if they say, I really love Diet Coke, and a possible health negative consequence risk is worth it to me, then have a Diet Coke. You made an informed decision. Congratulations, you're an adult.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
That's where I stand. I'm not saying the data are conclusive be all end all. I'm just saying these are cool data. Think about them. I think they're compelling. I don't know if you read the paper, but what you thought, but that's where my stance is.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And on the x-axis is exposure to LDL, exposure to LDL, cholesterol exposure to aqua B. And the y-axis is how much plaque actually accumulates in your heart. Some person can have a very steep slope, meaning with a little exposure, they get a lot of plaque.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And other person could have a very shallow slope, meaning for a ton of exposure, they actually develop very little or maybe even no plaque, not even a measurable amount. That difference is really, really important because people are trying to decide what to do with lifestyle or whether or not to take medications that do have side effects.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
A hundred percent. I stand by that as like a general rule of thumb. I don't care if people like have, you know, ice cream and grilled cheese for every meal and they're happy and healthy. Like at the end of the day, you do you and I will not judge you. I'm genuinely not like a judgmental person.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You just have to make your own decision, but you should make your own informed decision and also acknowledge there's no such thing as perfection. So, for example, you were talking earlier about microplastics in red meat, like in ground beef. Does that mean I'm not going to eat red meat? No. Like I'll have the ground beef. Maybe there's some microplastics in it. Boo hoo. Sucks. It's not ideal.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But, you know, I'd rather have that than go, you know, let's, you know, create the binary and say, go get like a pizza at Domino's. So know where Diet Coke fits in as a tool or maybe the lesser of two evils in your own life. If the truthful decision for you is really between a Coke and a Diet Coke and that's how you see things and you have the Diet Coke and you feel better than great. Fine.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I think it's a little bit of a weird binary, but fine. When I get criticisms about, quote, fear mongering, covering the study, basically, if you watch the full content, you can see it's not very detrimental. But yeah, it has a hooky thumb. That's what YouTube is about. You get some engagement bait. But I think they're
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
kind of alluding to the fact that I could be doing harm by dissuading people from having Diet Coke and then they're going to go have a Coke. It almost seems like the implication. I've never met someone once who were like, oh, X person on YouTube said Diet Coke is bad. I guess I'll just have regular soda.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I have gotten comments by people like, wow, this is the motivation I needed to just kick the diet soda pattern and just have water. And I've also had people say, this was the motivation I needed to kick diet soda, come back and then say, oh, wow, my migraines went away. So the cost of eliminating diet soda, even as an experiment, is negligible to benefits.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So I don't think it's a problem to be talking about these data, even in a sensational manner. And you can place the caveats at the end. Some people have problems with that. But I think like to say, wow, this is exciting. This is really interesting. Let's talk about the data, get people's emotions provoked, and then just talk about the data and let people make decisions. I think that's totally fine.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
In the universe of, let's call it, health sensationalism, I don't think spreading the message that, hey, diet soda might not be that good for you is that dangerous. I actually think it's probably going to hedge towards more beneficial. But again, at the end of the day, you do you.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And if a Diet Coke works for you and you want to flex that you have Diet Coke and you're super healthy and happy, guess what? I'm going to give you two thumbs up and say I'm happy for you, sincerely.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And in the context of a whole person, you always have to do this benefit analysis. It's not about snapping your fingers. You can't snap your fingers and change one biomarker in isolation. Say you're using a ketogenic diet to treat inflammatory bowel disease, but your LDL is really high.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It's possible, and I guess all I'd say to that is I agree with you. I don't believe that actually happens, not at least at any scale. I've never heard of someone being like, I saw a single Instagram flip that said Diet Coke is bad, and now I'm drinking regular Coke. I just it seems so hyperbolic and implausible to me that I don't think it happens to the same extent.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Like when I do Oreo versus statin, I was pretty sure that no adult human being will be like, oh, good. Oreos are a health food. Let me get off my statin and just start binge eating Oreo cookies and nutter butters. I just don't think people give the general public enough credit for common sense.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I think people want, with their engagement, nuance and depth and are willing to chase the rabbit hole a little bit before making health decisions. That's my perspective. Broadly, I think people are frustrated because the self-proclaimed intellectuals and gatekeepers of health information tend to patronize and be like, this is what you should do. And here's the simplistic way to think about it.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And here are the rules and guidelines without delving into the nuances. I don't think that's very compelling, nor do I think it's productive towards building trust. So I think it is okay to be like a little bit fun, engaging, provided you draw people in to then have the nuanced discussion and say, well, here are the data. I'm going to show you the graphs from the paper.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Well, it's important to know what's the absolute risk because what you might be trading by reintroducing carbs is an increased risk of flares and ending up in the hospital or trying a medication that might have side effects, promote insulin resistance or other negative health effects that you don't otherwise want. So I'm not here to say that LZL or Applebee is irrelevant.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I'm going to link you to other resources where you can have a set of links to the human randomized control trials and meta analyses and other studies and playlists where I delve into this topic. Go as deep as you want. Hear the data. Here's what I think about them. At the end of the day, you make your own decision.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I think that's a much more productive approach than just saying, we don't know that Diet Coke is bad. Therefore, you should have it. Because we haven't conclusively proven in the 30-year human randomized control trial that aspartame doesn't have a negative effect on the human heart. It's ridiculous. And I said this in a recent clip, the one I was responding to somebody did.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
They did take me out of context. They tried to make it seem like I was making a point that I wasn't based on what are pretty weak data. If data are fine, provided you're drawing the appropriate conclusion based on the data, the claim needs to be commensurate with the data supporting it.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So if data are early and you say, this is really interesting, and this shows X, Y, and Z, and then caveat, and this is what it doesn't show, that's fine. The precision of the words really matters. For me to say aspartame may cause heart disease and use the word cause is dead accurate. The animal models show it may cause heart disease. Here is the mechanism.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And then I couch it in the human data saying, here's what we know about insulin response with respect to aspirin in humans. Here's where we are now. If you look at the full context, the story is told. And my perspective, be it right or wrong, is that people deserve the benefit of the doubt that you can serve them that nuance.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I think, you know, first and foremost is, yes, seed oil can refer to a lot of different things. It can refer to highly oxidized, industrialized processed oils that are pre-oxidized, so really damaged fats that can be inflammatory. Right. Okay, don't drink the fire oil at McDonald's. They can probably agree that's not a good idea.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But there's kind of a logic creep because then people go to, oh, well, what's the harmful component? It's high levels of omega-6 spats. One primary omega-6 is a little like acid. And then there ends up with this, I'd say, fear mongering about omega six fat rich foods as a category.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So then you end up lumping in things like raw nuts, walnuts or sesame thing I brought up before in that same category is like fryer oil, McDonald's and all the industrialized processed oils I could put into our junk food. And I don't think that's appropriate. because literature does not show that it is necessarily harmful.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I'm here to say it's context dependent and that in assessing an individual's risk, you need to take a look at the whole picture. So, you know, TLDR is going over your head. Don't get your medical information, your health recommendations off of podcasts and YouTube. I'm here to provide information. But at the end of the day, key thing is to assess your own risk profile.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It does become a nuanced and curious area when we entertain the fact that, yeah, like if you look at, say, the omega-6 to omega-3 balance in the body, it does matter. So, you know, having a higher omega-6 and lower omega-3 can lead to a pro-inflammatory state.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Again, and this is where I might lose some people, but I think it's an important point to note what we can actually study in humans, because... The fact of the matter is you can't shift omega-6 to 3 ratio in humans without shifting other components of the diet because they're essential fatty acids.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So again, you need to turn to like animal models and you can show by actually genetically manipulating them that yeah, higher omega-6 to 3 ratio can be more pro-inflammatory. It'd lead one to speculate that in theory, you could get like an omega-6 to 3 imbalance by just like over consuming omega-6 fat in theory. I just think it'd probably be hard to do in practice.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Like I think it'd be hard to be like, I'm going to binge eat raw walnuts and it'll lead to negative health effects. And we don't have data to say that. Whereas I don't see a negative effect of saying, you know, aspartame may cause problems because if you kick that coke, what do you do?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I do see a negative potential effect of saying, like, you need to get rid of all omega-6 in the diet because then people are cutting out whole foods that could be healthy, like walnuts, tahini, or even in some cases, this is going to sound crazy, but I hear it, fatty fish. Because fatty fish is high in polyunsaturated fats, which are fragile. So you even get creeped there.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I had one person telling me that sardines were unhealthy because they're high in polyunsaturated fat, because they're high in omega-3. And they were truly convinced that a Quest bar was healthier and got very upset when I told them, no, I disagree with you. That aside, you can see where the logic creep goes.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So at a very high level, because I realize we don't have two hours to delve into just one topic, I'd say define what you're talking about when you say seed oils. If we're talking about industrialized processed oils, that's a different thing than saying anything rich in omega-6. And what I'd say is in theory, having a very high omega-6 diet
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
can be bad for you, but I would not actually say one should avoid whole omega-6 food, whole omega-6 rich foods like walnuts, various nuts, cold-pressed canola oil, olive oil is like 14% or something, omega-6, because these foods are generally, I'd say on the whole, pretty healthy. And... It's not a linear relationship.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It's not like if you eat 10 grams of omega-6 and 1 gram of omega-3, the ratio in your body is 10 to 1. It does not work like that. The processing is a lot more complicated. So I eat a decent amount of omega-6, far, far more than omega-3, and I eat a lot of omega-3 too, but it's just way easier to get bulk load omega-6. And my ratio in my cells, if I measure it, is a perfect one-to-one.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And I do not avoid things like walnuts or sesame. I eat them to my heart's content, fiber permitting. And my blood ratios of omega-6 to 3 are actually perfect. One-to-one ratio of omega-6 to 3 and a 17.2% EPA to DHA ratio, which, by the way, is way better than Brian Johnson. He has a table on all his biomarkers that it's like, I'm in the top echelon at 9.98% and I'm reading that.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I'm like, well, I'm at 17.2.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But with that caveat in place. A question that I think we should ask is why does LDL go up? We talk all the time about LDL, but not so much about the physiology behind what drives it. And people then tend to oversimplify and think, oh, it's just saturated fat. They're just, quote, butter guzzlers. Or it's just some quirk of genetics, right? Those are kind of hand wavy statements.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Well, Brian hasn't. And speaking of Brian, he hasn't gotten a CCTA.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
uh you know there's other voices that are out there not to name any names i think they'd be very shocked to see that their heart is maybe not as healthy as they thought it would be yeah no i mean on brian i'm i'm right now i'm honestly i'm interested to see what uh i don't know if you know what i've learned joseph everett uh i don't know he's a big youtube channel but he's had like a little bit of a spicy confrontation with brian he asked me to be interviewed on his channel so he's gonna be dropping a criticism video which i was interviewed for um
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I, the high level Brian is one of my favorite characters in the longevity space. Like truly, we definitely don't eat the same, but I think he, he has a very on the whole, um, open, uh, you know, authentic via humorous persona. And I think he is pretty transparent about his methodology and doesn't mind making a little bit of a joke of himself. I actually, I think it's very endearing.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I do have, if, if, you know, if I were to, this is my kind of core criticism to render at Brian. I haven't found, I don't know how you feel, but I haven't found his optics around the scientific rigor have been very solid. Sometimes he gets on podcasts and like, he is so thoughtful in long form. Some of my favorite podcasts we're having with, uh,
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Trevor Noah, and there was Diary of a CEO, and I heard him on Derek, more plates, more dates, like all three. He was so well spoken about the philosophy of do not die. But then my personal feeling was when it came to the logic behind the protocols, it was kind of opaque. And either he misspoke on some studies, which he admitted he did, like there was this olive oil study he misspoke on.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And in some cases, they're true. Saturated fat can increase LDL, at least a little bit. Genetics can play a role. But when you have a really interesting phenomenon, like someone going low carbon, their LDL going for like 300, 400, 500, saturated fat almost certainly isn't the only thing at play. And in some people, it's very weird because they even go like plant-based low carbon.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Or he deferred to his team, who are also pretty opaque. And I feel like the rationale behind their protocols is also opaque. So there are things that I've seen here and there that kind of get me to draw a little bit of a question.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
It's been one that my colleagues and I, Dave Feldman and Adrian Sotomayor, have been expending blood, sweat and tears on for a few years. And I really have to give most of the credit to Dave Feldman. This started with him. He's, if you don't know him, an outsider, an engineer who had this provocative question. We'll get into it.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
So as much as I like Brian as a personality, and I think he's thoughtful about his approach, what I would like to see more from him, now just taking my two cents in case he ends up listening to this or you poke him about it, is I would like... to see more rigorous science projected from him and or his team about the rationale behind the protocols as far as they're allowed to do.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I know that a lot of their information is proprietary, but in the interest of open science, I'd like to see more. And quite honestly, I... I see opportunities. I'm not saying this is just to be a troll, but I see constructive opportunities. I read literature on things related to olive oil that are groundbreaking. And I'm like, why haven't you covered this literature? You're selling olive oil.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You could do an original layer of pain. And there's a new study showing that in aging, calcium in poor into mitochondria goes down. And this affects muscle metabolism negatively. And actually, in animal models, if we supplement back this compound found in olive leaves, it increases endurance and even increases muscle mass. in aged mice.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And you could tell a story around that that is so compelling with the relationship to your olive oil. I mean, he's already doing marketing around olive oil. It's just very superficial stuff.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And so in reading the physiology and literature myself, as no expert in one particular area, but a broad interest, I actually am bringing this up because I see an opportunity for Brian to expand his impact by... I think he could get more rigorous with the physiology. And quite honestly, I'd be happy to help. Pro bono. I'm not asking for anything in return.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I just think what he's doing is interesting. And we're all looking to grow and communicate as communicators in this space. I by no means think I am perfect at it. I think we're all growing and developing. And I just see this chink in his approach that I would just love the opportunity to finagle and fine-tune because I think it could be scaled up.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And I do love what he's doing, particularly around... And this is where I think we have a great unity of mind, challenging norms, saying, just because this is the way people understand it today, screw that. How are people going to think about it in the future? We should evaluate the data, ask provocative questions, and push the boundaries of not only human knowledge, but human societal norms.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And I do think he does that really well. So overall, I give him big props. I just... He's an interesting character, and he's an interesting person from a social perspective to kind of try to decode and analyze.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
They'll still see this response. I can actually get to my LDL for like 300, 400 on a vegan keto diet. So you get to ask the question, well, what's going on here and what can we learn from it? That's where this population that we've been studying comes into play.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Thank you so much. I apologize for, I'm at that stage where it's like, you're, I mean, I'm sure you, you can, this resonates with you, but.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
you're kind of like a one-man team you don't have much support like i have one editor but you're also like balancing everything else in life because it's not a full-time thing so like i'm doing research medical student and then i'm like trying to dabble with socials at the same time and with all the dm streams i just get like some things just get missed but i'm so happy we circle back to have this conversation and i look forward to hopefully future conversations because uh
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I think we both plan, if a heart attack doesn't get us first, to be in this space for the decades to come.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
YouTube is where I'm most active. I have a lot of fun breaking down the science there. Um, and also my newsletter stay curious metabolism is where I kind of do my first digest. So often like paper comes out at like 4am and sell and I'm up cause I can't sleep. You could have like, you know, I digest the paper by like 7am cause I just like, that's how I operate. I'm like, this is exciting right now.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I need to cover it. Um, and so, you know, I engage with me on whatever your preferred platform is. And provided your input and comments are sincere and thoughtful, I really do appreciate constructive criticisms. I'm kind of, you know, I'm finishing my rookie year in this, so to speak. And I look forward to growing with everybody. So their feedback is my data. And thanks for having me.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Because what appears to happen when lean insulin sensitive people go low carb is when they're no longer relying on carbs as much for fuel, specifically what happens is the carb stores in the liver, which defend blood glucose stores when they drop, it triggers this cycle whereby you're burning fat
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And some of the fat that kind of, you could say, spills over gets taken back up into the liver and then recycled through the body through a trafficking system that depends on cholesterol. So specifically, you have these big, you could say, fat-carrying boats. They're called VLDL particles, very low-density lipid particles.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You need them because fat, stored fat, doesn't mix with aqueous solution, so water. You know that if you take water, Oil, you put it in water, it doesn't mix. So it's the same way with fat in your body. It doesn't really mix well with blood. So you need a way to carry it around the body. And it gets packaged, the fat, into these shipment containers that contain cholesterol.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And in circulating around the body and dropping off fat back at fat tissue and muscle tissue, the result of that can be very, very high LDL, which can actually be reversed in these people by just adding back carbs, which is why I can lower my cholesterol with Oreo cookies, which I've done and published on. You're laughing now, and it seems like a joke, and to some extent it is.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
You have to ask questions like, well, why would I do a stunt where I publish a study where I lower my cholesterol with Oreo cookies? It's not because I think Oreo cookies are a health food or I want people to eat them, but I want to get attention to this fascinating physiology. Yeah, of course. It's clickbait for me to eat Oreo cookies and lower my cholesterol. It's also legitimate science.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And if it opens up a conversation about what's going on here, what can we learn about this population, and how can we rally to study this population, I think that's very worthwhile. I just want to make the point that in science, the greatest discoveries, let's say the most impactful discoveries, come out of just pursuing these curiosities. Why does my cholesterol go down when I eat Oreo cookies?
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Delved into lipidology, became obsessed with it, crowdfunded a clinical trial and executed on it. And we've been working on this area of research. We've had like 10 papers on it over the past couple of years.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
Why does Gila monster venom screw up the metabolism of its prey? People studying Gila monster venom in the 90s, they didn't know what would happen as a result of the studies. Guess what? The result of the studies is basically the modern era of weight loss drugs. Ozempic, Wigovi, GLP-1 receptor agonists are a result of studying Gila monster venom.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
In the same vein, what we're doing now can have knock-on effects and knock-on discoveries that I think are generalizable to every single human being. If just then now in the modern era with social media, people get to see it happening, the science happening in real time.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
But this is really the landmark study because what we did, what the team did was take this group of people that turned lean mass hyper responders, these people who go low carb and see their LDL go through the roof, like sky high levels and followed them
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
What I would say is, why do they have a baseline? Well, these people, the average age at time of enrollment was about 55 years old. And at that point in time, average time on a keto diet was 4.7 years. So if you do the math, these people didn't start a ketogenic diet on average until they were over 50. So they had the first 50 years of their life when they were doing other things.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
They might have been eating a standard American diet, might not have been living a healthy lifestyle during which they could have had plaque accumulation. You know, just because you adopt a healthy lifestyle doesn't erase decades of living another lifestyle. So it could just be a phenomenon of You know, their prior diet, their prior exposure, their prior lifestyle led to plaque being there.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
And then the change of diet didn't just make the plaque suddenly vanish. So there was like a you could say a chink in the blood vessel armor, so to speak. And that, you know, seed preexisted as they were going on to this this trial. So I think that's probably the most likely phenomenon. There could be other phenomenon as well. I mean, there could be genetic contributions, for example.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
I guess we'll never know for certain, but I would say the most likely explanation is that people spent 50 years living another way. Probably that contributed to life progression. It's far more likely than blaming it on a few years of a ketogenic diet.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
over the course of one year with high resolution CT angiography to look not just for calcified plaques, but also non calcified plaque to see does plaque progress in this population that conventional wisdom would say is that super, super high risk their LDL levels are 200, 300, 400, 500. Sometimes it's close to 600. We had one person in this trial with an LDL of 591.
Dhru Purohit Show
This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
What I would say is, you know, we have 100 people in this study. Actually, 100 people that enrolled in 100% retention. So no dropouts, which is actually pretty stunning. Just, you know, props to the participants. That's remarkable. But We didn't do a deep dive into every single lifestyle factor that every participant had. That was beyond the scope of the study.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
The Oreo cookies lowered my LDL by 71% in just 16 days. I think the top 10 drugs only help like 1 to 4 to 1 in 10 people who take them.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
The way we go about modern medicine now is trying to prune the tree as the branches grow. The fact of the matter is they're just gonna keep growing back. And I think the mind shift we need is to look at the roots in the soil, which are these underlying pathologies, things you mentioned, like insulin resistance and inflammation, that are at the root of all chronic metabolic disease.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And when we make that mind shift, we can gain insight into, I think, how we can more potently address disease, and also why certain fundamental interventions might hit a lot of different diseases. Like, yeah, depression and schizophrenia in addition to obesity. And it's not because it's snake oil.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
It's because they all have the same underlying dysfunctions that just manifest differently in different people with different susceptibilities.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
An Oxford PhD who reversed his own chronic illness.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I figured I hadn't, I might have like heard, I don't know where I heard it, but I'm like, I couldn't have created this. It's just so obvious.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
A few things I want to respond to there. One, with respect to why doctors don't order these sort of tests. I mean, first rule of medicine is don't order a test if you're not going to do anything with it or you don't know what to do with it. So I think a lot of people don't know, you know, if somebody comes back with a high insulin resistance score, there's not a pill for that.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So how are you going to manage it in the current, you know, medical system? Whereas, you know, if you measure an LDL cholesterol, we very clearly have a pill that can target that biomarker and you can get an easy win on paper. I'm not saying that, you know, statins don't have their place, but in terms of like why someone would test for one thing and not another, it is the treating clinician.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
What are they equipped to handle in terms of data? How do they know how to manage the results and what tools do they have to prescribe?
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So the second thing I wanted to say, you just alluded to it when you're like, eat better, eat less, is circling back to what I used to see nutrition as, which I thought was a fluffy science. And I think a lot of conventional medicine still sees it as a fluffy science. Take that as, you know, the internalized perspective of what nutrition is.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And now I am juxtaposing that, contrasting that to what I'm studying. We were talking about a few things offline, but things that I read that come out like every day, every week in the metabolic health literature that are just jaw dropping.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
like a couple examples i was was mentioning was how the body produces cyanide to boost metabolism like that's weird i didn't expect that or how there are cells in the brain support cells called astrocytes that can literally like reach out cytoplasmic arms and connect with neurons and suck out damaged proteins and then donate healthy mitochondria
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Yeah, so the pathological hallmarks of the, you know, leading neurodegenerative diseases, Alzheimer's, Parkinson's, they come down to misfolded proteins. Imagine if you had a cell in the brain that could stick its arm into a neuron, pull these out, oh, and by the way, these damaged proteins harmed mitochondria, the powerhouse of the cell, so let's replace those.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
You stick another arm in, and you give the healthy mitochondria. Like that's something that literally happens in the human brain. A lot of this is in the area of preclinical.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
You can imagine this is a very hard thing to study in a living human, but just understanding the fundamentals of the physiology, the biology, the metabolism, gives us insight into one, just how remarkable our bodies are, and two, gives us insight into how we can tweak these systems
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
in profound way to get astonishing results, like lowering your cholesterol with Oreo cookies or like, you know, sucking damaged proteins out of brain cells. They can give a lot of examples.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
But so the reason I want to frame these two things and I want to add in another element is what you said about people just throwing their hands up in the air and being like, too complicated, I'm done. I'll just do whatever.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
If they can't figure it out, what am I supposed to do? What I hate is the platitudes around nutrition. Things like eat a balanced diet, eat the rainbow. I think they're just so useless because they're just platitudes. They have no deeper level of thought. And on the other hand, you have this really cool physiology
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
But if I say to a person, isn't it cool that glycine can increase cyanide production in lysosomes, it's gonna go completely over their head. So how do you, as a communicator,
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Take your love and awe for metabolism and health and transform it into nuanced functional takeaways for people so you can bring them along the journey of genuine learning and exciting them about this physiology while not just giving them platitudes, but give them takeaways that are actionable, which hopefully does not include chugging cyanide or misleading information around that.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
You can see how it becomes an ecosystem of confusion, I guess you could say. And like, how do you give people the respect of feeding them a nuanced message while also not confusing them is I think a really interesting challenge that I've had at the front of my mind for the last year.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
To frame up why this is so important, I would first say that we've already mentioned that carbohydrate-restricted diets can help with a broad range of conditions. With ketogenic diets potentially helping with like severe mental illnesses, depression, schizophrenia, bipolar,
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
But however, there's an obstacle to clinical implementation of these diets broadly, and that is some people have these astronomical jumps in cholesterol, in particular LDL cholesterol, and that scares physicians. Just reinforcing what you said, but the reason this is so important is it's a deterrent from prescribing these diets to people who could
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
genuinely benefit from them as a metabolic health therapy. So it's a critical question to answer. One, who is susceptible to these increases in LDL? Because it's only a minority of people. So it's a minority, but it is a decent population. Why in some people and not others? We need to identify that population. What's the mechanism?
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And then also what's the risk associated with the high LDL in different contexts? And we need this information in order to promote the adoption of ketogenic diets for a broad range of conditions and properly treat people on an individual basis. So with that framing,
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I would say one really interesting observation that explains why only a minority of people see increases in LDL on low-carb ketogenic diets is that there is an inverse association between your BMI and LDL change, meaning the leaner you are, the higher your LDL goes.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Mine's like 500, 550. And we can get into the saturated fat or something later.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
We can talk about my profile later, the contributions to that. But with respect to the literature, we did a meta-analysis of the 41 human randomized controlled trials with low-carb diets where we had the information to look at LDL changes and lipid changes. And what we found was if you broke it up by BMI category, The only group of studies where LDL went up was BMI under 25, the lean group.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Overweight, class one obesity, no increase. Class two obesity, LDL actually went down. And if you look at the individual participant level data, there was an inverse association across the BMI spectrum, where the leaner you were, the higher your LDL went. So this is encoded in the human randomized controlled trial literature. And I'll give a big hat tip to my friend Adrian Sotomoto, who is the...
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
uh guns behind that one the first author and then david ludwig we worked with on that paper what happens when people who are obese yeah and diabetic become thin and fit healthy and have more mass that's the fascinating thing so do they flip over to the other side i've seen this happen i've seen i'll give you one instance was a patient with a starting bmi of 43.2 that's big that's very big and actually you had low lvl baseline like in the 80s
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Despite that, you know, I mean, they had high triglycerides, low HDL, and probably a pattern B LDL phenotype, but they had lowish LDL at 80. They started losing weight. They went on a ketogenic diet. They were losing lots of weight. BMI went to 30, 27. And right around BMI 26, 25, their LDL took a hairpin turn, where it was more or less stable, sub 100, and then shot up to 250.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
just shot up as they got, they didn't really change their diet at all. They just got into this lean area and their LDL went through the roof.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So as a practical takeaway to people and things I'd highlight for the healthcare practitioners listening is like, if you have a patient with insulin resistance, type two diabetes, obesity, and you're interested in trying a ketogenic diet for them, they're very unlikely, to see the LDL change that might scare you. They're unlikely to have that response.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
There might be a transient bump that's small that comes back down. We do see that in the literature. But as for this like jump to 400, you're unlikely to see it. So I think a few things that really need to be reconciled that are points of confusion around this are terms like, you know, LDL is causal and necessary for cardiovascular disease. in this idea of context dependency.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So what I'm not saying is that LDL or Applebee don't matter. I'm also not saying they're not part of the causal cascade. They are. But just because something is part of a causal cascade and necessary doesn't mean you need to treat it. Because context matters so much. Explain what you mean by context. in the context of the rest of their metabolic health?
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Their metabolic health is one element of context. The context around like, what is actually driving up the biomarker? Because biomarkers can change for different reasons. And you can start to gain insight into why a biomarker might be where it is when you start to know the whole patient story. Yeah.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Which is why, again, I teased it, but like I legitimately can lower my LDL with Oreos more than I can with a statin. That is not generalizable, but it comes down to the context because when you understand the physiology, you can get amazing results.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Explain that. So first, why I did this, people are going to say, well, isn't this clickbait? Oh, 100%. It was engineered to be clickbait. I was trying to engineer the most clickbaity experiment I possibly could to start a really important discussion about fascinating physiology. So it was clickbait backed by legitimate science.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Now, at the point I designed the experiment, we had already had about 10 papers on this topic. One, they weren't getting talked about, I think, enough. And two, there were what I perceived as efforts to not only suppress the dialogue, but circumvent it with misleading messaging, intellectually misleading messaging. I can support that. I realize that sounds like a strong claim.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I'll give examples later. But with the resources available to me at the time I was 27, I was like, how can I force this discussion? I am not a esteemed professor emeritus. I do not have millions of dollars. I don't even have that big a social media profile at the time.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And so I'm like, I want to engineer something that...
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
will catch attention and hopefully bring people towards a more nuanced discussion that needs to happen so i designed this study and to be clear i designed it and announced it before i did it i thought it was the appropriate scientific thing to do saying like this is my prediction based on my understanding of the physiology then i'm going to do it it's your hypothesis hypothesis um i announced it on you can even look chris mccaskill goes by plant chompers is a prominent vegan i announced on his platform
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And I said, what I'm gonna do is an experiment. In this experiment, I'm gonna lock in my diet as a kind of strict baseline ketogenic diet, my normal one, for a couple weeks, and then I'm gonna do an intervention where I eat Oreo cookies, a sleeve per day, so that's 12 cookies, about 100 grams of net carbs, in addition to my diet. So I'm not swapping out fat, I'm adding this.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So I'm actually adding saturated fat, along with sugar and carbs, for about two weeks, and then I'm gonna do a washout period, kind of reset everything, and end up being a three-month washout period, And then I'm gonna try high-intensity statin therapy. So it was Crestor, 20 milligrams for six weeks. Gorilla statin.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I wanted to steel man the comparator, which in this case was, you know, frontline therapy, statin therapy.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
In addition to this, I know how to dot my I's and cross my T's, so I went to Harvard, their institutional review board, got the appropriate exemptions for this experiment, had my PCP ordering all my labs into my electronical medical record, and then I got a consultant lipidologist, I don't know if you know Professor William Cromwell, but he trained Thomas Dayspring, Thomas Dayspring trained Peter Attia in lipidology.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So, William Cuomo, over 30 years of experience, he's the senior author on this paper and was consulting. So, I did this as by the books as you could in Oreo experiment. And then I executed and published the results, which were that the Oreo cookies lowered my LDL by 71% in just 16 days.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Now, the reason it was 16 days and not 14, I had mentioned two weeks, was because at the two-week mark, the drop was so astronomical. We wanted to make sure it wasn't a lab error, so we wanted to triplicate. So we said, we're going to measure the next two days. And it was still dropping. So that was the effect of the Oreo. And then the statins lowered my LDL by 32.5%.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So more than double the effect of the statin by eating Oreos.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Me understanding the physiology in myself. So we talked about different things can drive biomarkers up or down, and the context matters. So our understanding of why lean people have high LDL and low carb has to do with the fact that the leaner and the more insulin sensitive you are,
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
when you go low carb when you go keto and the carbohydrate stores and your liver starts to drop it kicks off this cycle whereby you're burning a lot more fat as fuel and you're actually releasing more free fatty acid from your fat cells into your bloodstream and then those free fatty acids need to cycle throughout the the liver and then back through the body so they get taken up by the liver packaged on these big ship-like particles containing cholesterol and stored fat
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
They're called VLDL. And then the VLDL dropped the stored fat, the triglycerides, back off at the muscle tissue and the fat tissue. And what happens in this process is that those big particles that are packed with the stored fat have the fat siphoned out of them. They shrink down into LDL particles that contain LDL cholesterol. And what you end up with as a result of this system is very high LDL.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
It's like a decay product of the thing that was transporting the energy effectively. An epiphenomenon. So yes, there are these particles that are the precursors to LDL. They drop off their cargo, the fat, at fat tissue to replenish small fat cells and muscle tissue. And then the VLDL will shrink.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
the vldl has a lot of triglycerides in it it drops off the triglycerides and becomes an ldl which sticks around longer than the vldl so what you end up with is actually very low triglycerides because the triglycerides get sucked out so fast triglycerides are low not high your ldl ups are being very high because the vldl are being turned over really really quickly into ldl and then as an added nuance when the vldl shrink remember they're big spheres they lose surface components
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
from their shell, you could say, and some of that is cholesterol that gets picked up by HDL. So the result is this pattern of very high LDL, high HDL, and low triglycerides. The high LDL, the high HDL, the low triglycerides with particular thresholds is what we call lean mass hyper-responders, and is this pattern we see on lean people who go low carb.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
But we can get a little bit more into the model if you want, but the point is the model starts with your metabolism shifting towards lots of fat burning. So if you put carbs back into the system, it puts the brake on the system, or at least takes the foot off the gas pedal, and your LDL should drop. That is the prediction of the model. So it should drop with any carb.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
The fact of the matter is, even before I did the Oreo experiment, we had used sweet potatoes in patients. There are case reports on this, or fruit, or starches. It just wasn't sexy enough to catch headlines. So I'm like, what is? And I'm like, Oreo cookies, that should do it. So I did a rigorous controlled experiment with my locked in baseline diet, a pure addition.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
You can look at all the macro breakdowns in the paper. And the result was the Oreo cookies lowered my LDL by a dramatic 71%. And I'll just say as an aside.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Well, the fact of the matter is, I think you learn so much in science and medicine by studying the outliers. And when you do the randomized control trial, yes, it has certain benefits, but you're, by the nature of the study, looking at a large group of diverse humans. So when you get a, quote, statistically significant result, that doesn't speak to any individual in the trial.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And if we want to shift medicine towards more focusing on targeting underlying metabolic dysfunctions in an individual manner, then we need to start taking the mindset of N equals one medicine. And we have more and more tools where we can do this.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Things like multiomics, where we take an individual's genome and microbiome transcript and you integrate them into an incredibly high resolution picture of the individual. If you take that mindset, then you can get incredible results. in a reproducible manner, like lowering your LDL with Oreo cookies. I'm not saying that's healthy, I'm just saying it's incredible.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And it's explainable when you understand the physiology. And is it generalizable? I've actually had other doctors at Harvard replicate this who are lean mass hyper-responders. There are actually quite a decent number of lean mass hyper-responders, people at Keto at Harvard.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
keto carnivore who are or in the uh medical community yeah i mean they not just sort of like studying history but no i know senior attendings who are like carnivore lean mass hyper responders and they're not out about it because it's stigmatized they don't want to have to deal with the headache that has that comes with like putting that target on your back so most of the time like a paper will come out and they're like did you see this bs about red meat will you like respond to it i'm like you want to get up there with me
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And they're like, nah, nah, you do it. It's true, it's a very stigmatized dietary pattern, keto and to a greater extent carnivore. People generally, be they, you know, your person in the general public or, you know, a senior MD, PhD, are gonna do what makes them feel good. And so if that helps them function and feel good for whatever reason, they're probably gonna do it.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
They might not be out about it, but.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I would say are more important.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
But I am being scientific insofar as that we can quantify the risk associated with different biomarker changes, and LDL is not the most important biomarker. It doesn't mean it doesn't matter. I didn't say that. That doesn't mean that it shouldn't be treated, you know, in certain patients. But in terms of, is it the most important biomarker? I feel like we can say no pretty confidently.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I think it's even more. I think the, this might've even been in a documentary you were in, but you're talking about the women's health study. And I think the hazards ratio for a high lip lipoprotein insulin resistance score was six plus. And for LDL it was like 1.38. And since one is nil, a lot more than six. Whatever, you know, 500 divided by 38.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
That's a complicated sphere.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
The fact of the matter is people don't need to wait. for authority's approval before trying something when it's a dietary therapy. They have access to it.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Now, I think people should do it in a nuanced and responsible manner, but in order to empower people today, what I love is exciting people about this metabolic health journey and getting them to engage in the process of what I call like N equals one science on themselves.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
where you identify an outcome you want to change in yourself what do you care about it could be you know you improving brain fog it could be your weight it could be depression it could be your gi symptoms it doesn't matter what it is choose your outcome then hypothesize what might improve that outcome like a scientist create a hypothesis then execute on that and collect your data.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Your data could be something objective, like a biomarker or a weight on the scale, or just subjective data, and evaluate the outcome without judgment on yourself, but curiosity with respect to the data, then iterate forever on yourself.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
that is what is living the n equals one lifestyle and that is i think how every individual even today even in the ecosystem with like the food booby traps we have everywhere platitudes around health misinformation if you really adopt that mindset and engage on that learning journey you will achieve
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
incredible health results that are beyond your wildest dreams i truly believe that i've seen it happen again and again including in people who don't have any scientific or medical background one of my favorite examples is i don't know if you've come across dave dana on uh social media but he was a guy that i met must have been 2022 maybe it was 2023 i think it was 2022 but when i met him he had poor mental health depression was over 400 pounds
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
and he wanted to improve his lot in life you can imagine like a lot of people he tried a lot of different diets that hadn't worked and was just kind of in a place of learned helplessness but also like a lot of people had this fire in his belly to get better he just didn't know how to direct his energy so we started working together a little bit um i did honestly very little for him other than give him just a little bit of support encouragement and information but i saw this light flick in him at one point where he got that mindset where he's like actually my metabolic health journey is a
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
curiosity and a privilege, not a chore. And I'll fast forward to where he is now, which is he's lost more weight than I am as a fully grown adult male. I don't know how much weight at this point, but a lot, probably close to 200 pounds. He got his, you know, financial books in order. He cured his depression. He got married. He finished an MBA. He is just announced that he's going to be a father.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Oh, and by the way, just as an aside, he's partying with Arnold Schwarzenegger on Venice Beach and at Arnold's house. He's become such a fitness icon among people that struggle with similar journeys. The point here is I genuinely believe that the gas achievable for every single person.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
If we construct supportive communities and encourage people to engage in metabolic health learning and try to meet them best where they are.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
First of all, thanks for having me. I'm very excited to be here and have this conversation. As for my backstory, I grew up in a household of both my parents are MD, PhDs, and I always wanted to do medicine and science. I was always fascinated by biological sciences. I always had high esteem for the medical profession. So that's always what I wanted to do, as long as I can remember.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
You said something interesting where you said environmental impacts, and we're going to leave this aside for now. I don't want to leave it aside. I actually want to bring it up because
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I think the reason that there's such a great PR machine around a vegan diet, or let's even just broaden it to say why a lot of people are very attached to certain ways of eating, is because food is such an emotional thing that Topics bleed into each other under the surface.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So it becomes very difficult when we're talking, say, about a carnivore diet, and I'm like, you know, this actually might be an incredible therapeutic for people with inflammatory bowel disease. People don't hear that. People don't hear that I'm saying.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Or they create, that undertone bleeds into the topic so they do mental gymnastics in order to negate or ignore or overlook what I'm actually trying to say, which it might be a very precise statement. For people with treatment resistant inflammatory bowel disease, this might make sense as a therapeutic.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And so I think it's important to acknowledge that diet touches on a lot of different things, animal welfare, climate change, and that while all these things are important, We do need to parse them in order to have precise conversations. I agree. Where we actually like evaluate the data as objectively as possible.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Well, I would say by and large, I'm diet agnostic when it comes to metabolic health. And what I mean by that is the great thing about metabolic health is the proof is in the pudding, how you feel in your biomarkers. So if an individual achieves great health, biomarkers, disease remission on a vegan diet, I will applaud them and be happy for them. Have you seen that?
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
i've seen people who profess to it i i mean i believe it's doable i believe it's not necessarily easy it might require supplementation i i believe it is possible i i don't have any reason to like fully doubt it and i will give that the benefit of the doubt i i don't think it's a fair assumption which is often a common assumption that eating the higher proportion plant-based you can eat the healthier you are i think that is a problematic reasoning
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
That said, I had a very fluffy idea of what nutrition science really was. I think my understanding- Fluffy idea? A fluffy diminutive. It was kind of not real medicine. Yeah, it was one of those things where I think a lot of people still think, oh, I kind of know what healthy is. My plate, before that, the food pyramid, eat a balanced diet, eat your five a day. I would say a lot of platitudes.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Again, it comes down to biomarkers. Well, not biomarkers, but like, what is the proof? How are you actually doing? And what does a particular dietary intervention actually do to you? So I'll give an example where I can actually construct a scenario where I go from a very saturated, fat-rich, animal-based, carnivoresque diet to a vegan diet and spike my LDL. and Applebee. I've done this.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I have the video breaking down how I did it. Yes, it's a party trick. Nevertheless, it's, again, legitimate and resulting in a change in a biomarker that I would say the vegan community thinks is particularly important. Probably LDL. So it's just like throwing the wrench in there of saying, look, there's so much context around this that
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Do whatever you want with your diet, but don't be deluded to think that just eating more plants is gonna make you healthier.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I like it.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
All right. I'm going to tease you before I talk about carnivore. Yeah. Brian Johnson. Is he healthy?
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
but platitudes that people take as gospel. I generally felt that way as well. I kind of knew, or I thought I knew, what healthy was. You know, I eat my fruits and vegetables, not too much saturated fat, not too much salt, and then get enough energy to fuel my activities. And blessed or cursed, I don't know what you want to call it, I was a young person who never struggled with my weight.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
One thing you said there stood out to me, which is not for most people. And I think something we both agree on is that it doesn't really matter what works for most people if it works for you at the end of the day. With that, it's probably a good transition to talk about benefits of carnivore.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
We've gotten most of our protein sources from animal-based foods, I think. for most of our evolutionary history.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
But one would also argue that like when we were evolving, there wasn't a selection pressure for like longevity that our priorities as individuals and organisms have shifted. So how far can the evolution perspective really take us in assessing what's best for our health?
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
mentioned earlier in the pod that i had a very negative view of keto before i started it but over time i've developed an interest in probing areas of taboo carnivore is definitely one of them when it came up on my radar my first response was like this is absurd i can only meet diet this can't be healthy for you despite how i'd changed my mind on things before but i like playing devil's advocate so it started i started to dig into it a little bit more and what i found
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
was that there was actually a lot of basic physiology and biological plausibility
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
to align with some of the things that people report clinically on a carnivore diet like remission of inflammatory bowel disease which is obviously of interest to me so since that point in time i've been delving into it as a topic a little bit with respect to you know writing case series we had one on a carnivore diet for anorexia because that's obviously very controversial one for a carnivore diet for inflammatory bowel disease where we're like you know we did full medical histories we had lab reports colonoscopy reports
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And we interviewed, I interviewed like 10 patients and to hear their stories, people saying like, you know, that they had had Crohn's or colitis for a couple of decades, been through a litany of immunosuppressants, been through surgeries. And this was the first thing that really like brought them back to life and gave them a new life. Like you can't ignore that. No.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
especially when it's dozens of people. 10 were reported, but there are many more. And then you square that up with physiology that actually makes a lot of sense, like carnivore is usually keto, ketones in the gut reduce inflammation, higher ketone levels in the gut associated with lower IBD activity,
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
There's even literature showing how fiber elimination can have a therapeutic effect via changing called mucosporilium, I think, a pathobiont on the gut that can put pediatric Crohn's disease into remission. I didn't know before studying it, but actually fiber-free liquid diets are quite commonly prescribed for refractory pediatric.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I was a pretty athletic young person, so throughout college, high school and most of college, I really didn't think much about my diet. And then things took a little bit of a left turn for me at the end of college when I started to develop inflammatory bowel disease. Before that, I was known as like- Like colitis. Colitis, ulcerative colitis.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And it's like 60 to 85% of cases respond. They don't teach you that in medical school because it's like, you know, I guess heresy against the beneficial effects of fiber. But say for that particular use case, I was seeing so many stories. And when I say stories, I do mean like with medical histories, lab reports, colonoscopy reports that are just overwhelming along with interesting physiology.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And it comes back to this question of, or the topic of absence of evidence isn't evidence of absence. Like nobody's done, the $3 to $5 million randomized control trial of a strict carnivore diet versus a vegan diet for IBD. I have my hypotheses about how it might turn out. I'd like to see it done.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
But that's the reason this isn't, or a reason it's not prescribed is because the studies haven't been done. It doesn't mean it can't really benefit people. Coming to that realization and feeling it's the intellectually honest thing, then abuts against some of the, what I would call intellectual dishonesty I see in the media and the scientific literature around carnivore diets.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I'll give you a case in point. Did you see that JAMA Cardiology case report that came out about the flax on the hands?
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Yeah. So there was a report that came out a few weeks ago as we record this. It was in JAMA Cardiology. It was a case report. of an individual who went on a carnivore diet and had, they say, cholesterol oozing from his skin, if people want to Google it. And there's these pictures of, you know, these yellow plaques on his hands from eating presumably a carnivore diet.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Now, you look at the report, and it was word limited, but you look at the report, and the entire description of the patient was a man in his 40s.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
was the description didn't even give us the exact age no medical history no family history no genetic history and they described his diet as him eating six to nine pounds of cheese butter and beef daily wow which is actually implausible so this didn't read like a case report this read like a skit from monty python you know what the fat man i'm like this is not plausible how did this get published right i'm all for cautionary tales but this is intellectual dishonesty yeah
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And if people actually do read the report, it was worded a little bit vaguely around his diet. The first author did get on the news, I think it was Fox News, and doubled down on the fact that he was reporting six to nine pounds of cheese, beef, and butter intake per day, again, for eight months, implausible. So this isn't a legitimate report.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
nine times four oh yeah no i mean when you go to like get a 16 ounce ribeye no bone that's a pound so the least he could eat was six of those per day every day the least for eight months not you know even mentioning the density of cheese and butter wow a human being can't eat this like it not not even like i don't know eddie hall or like the mountain from game of thrones probably eats this one maybe them but you can see his hands it wasn't that person so anyway
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So what that looks like for people who don't know, sorry if this is a bit graphic, but bloody diarrhea 12 to 20 times a day. Yeah, no fun. No fun whatsoever. And it was a really big shift for me because before that I had no dietary restrictions. I was known as the trash compactor of the family and my friend group. And I loved adventurous eating. It was one of my favorite parts of traveling.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
this was just one example of what i would call intellectual dishonesty in order to if i were to make the steel man what they're probably trying to do is project a a conservative and cautionary tale in order to dissuade people from doing something that people presume is harmful.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
But the fact of the matter is when you have a pattern of reports like these, and there are a pattern, I can go through other examples. What ends up happening is the community of people who have benefited. That is their narrative. You're not going to dissuade them otherwise. If an individual has benefited, they feel they've benefited.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
See this for what it is, intellectual dishonesty, double standards, and then trust is lost.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
yeah and that is dangerous trust is lost in science and medicine so now why are they going to believe anything else that comes out of jama cardiology because this nonsense came out right and it evidently was nonsense so that's one of the top medical journals so it's not like some happened circulation too with a report where they just basically lied through their teeth and in both these instances there is no actual like good recourse so they don't accept letter to the editors i tried to do one for a circulation report they said
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
You know, it's a case report. You can't actually do an e-letter. I emailed the journal. I emailed the first author. No responses. I even told the first author in an email on this general cardiology report. I said, like, this report seems deficient. If you have more details, I'm willing to help support you writing in the full case report as a cautionary tale. We want a detailed dietary record.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
If you want to get genetic testing, we can do it at my expense. I'm not against N equals one. I'm not against cautionary tales. I'm not against case reports. I'm against intellectual dishonesty. Right. And there is so much when it comes to meat and carnivore diets, and it just pervades the literature.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I was reading a study in neurology about red meat and dementia, and they cited a study where they said saturated fat is bad because it lowers BDNF. And the study was a mouse study where the mice were fed an HFS diet, which stands for high-fat sucrose diet. Yeah. So they were throwing saturated fat under the bus, citing mice eating sugar.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And milkshake is not a steak. Again, relatively diet agnostic, but I do think there's a systemic bias in the media and the scientific literature against red meat and certainly carnivore diets. And I like to call that out.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I don't think there's anything magical about meat. So I wouldn't say it's the meat per se. I would say that it's an elimination diet. But if the universe of foods that is an irritant to you is basically everything but meat, Does it make a difference?
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I think it's weak to non-existent. I think most of it comes from large-scale population studies that are skewed by profound health user bias and then mental gymnastics that people do and statistical manipulation to reinforce the narrative that red meat is bad.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
You can catch me eating basically anything.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
um but i went from that to being able to eat basically nothing that didn't upset my stomach just to kind of give insight to the psychology of or the psychological impact of something like ulcerative colitis you become well i'll say the physical impact is only a tiny fraction the tip of the iceberg of the whole impact because it really causes you to withdraw from life socially psychologically
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
i would just to be fair to my own standards point out that for some of the outcomes that you'd be interested in say like a heart attack it'd be really hard to do a randomized controlled trial in humans looking for that outcome where you just have like a very controlled meat intervention despite that i still think the balance of literature is is very weak and you can even see that and you were mentioning you were talking to somebody with you know on or related to the dietary guidelines like i don't know if you read a draft of the
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
the guidelines or the data behind the guidelines for 2025. But I look through it and they even say they're like how weak and limited the evidence is. Nevertheless, red meat is bad for you just perpetuates as a meme because it's already taken on a life of its own.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
To go back to the study that I mentioned before, or was mentioning before about the mice fed the high-fat sugar diet and then having saturated fat thrown under the bus, the broader point of that study was about the media was running with it saying red meat was bad for the brain, when, as a matter of fact, there was tremendous health user bias
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
unprocessed red meat was not associated with dementia in any way shape or form was only the processed red meat and then when you looked at the physiologic explanations there was nothing there that was specific to the unprocessed red meat which were the only place they found the effect in effect the study said nothing negative really about like say a steak nevertheless it got presented
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
the public as don't eat red meat because it's bad for your brain. Instead, have a cauliflower because we can take this nice sagittal section and make it look like a brain and, you know, feed into your base human emotions.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
By and large, yes.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I agree. And to that extent, speaking about forests and plants, I just want to be very clear. Me saying a carnivore diet can be beneficial for certain people and red meat's not bad is not saying all fruit is terrible for you in all circumstances. Fiber is bad for you. Like these are consistent ideas. And I think people get so captured in one camp that there are presumptions based on
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
unrelated statements. So red meat, not bad for you. Red meat can be a health food. Does it mean brussel sprouts are poisoning you or broccoli's a conspiracy? No, it does not. If you tolerate those foods, I think they're perfectly fine. In fact, I'm quite jealous. I love brussel sprouts. They just don't agree with me. So.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
At this point, I'm finishing up college, starting grad school. And as a young man, you'd imagine I would, you know, be going out with my friends, dating, just to kind of give like a quick example. Dating's not really on the table when, you know, if you're going to have a girl over, you might have bloody diarrhea in an instance, not really a...
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
This will be the first time I probably announced this on a platform of this size, but I took the very big step and decision of deciding I'm not going to apply to medical residency. Now, you know the weight of that, but just to clarify it for other people, if you don't do a residency, you're not a practicing clinician.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So I have spent my entire life imagining being a practicing clinician and doing everything by the book, which means getting into the best college I can, best grad school I can, best medical school I can, and I've basically done all that. And then you, you know, go to residency, you go to fellowship, you run a lab, you, you know, do everything in a nice professional academic jade tower manner.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
To give that up at this late stage is a big deal. Because on the one hand, people could say like, well, what was the point of medical school for you? What I've been thinking a lot about as I observe from my interesting vantage point as a patient, medical student,
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
um trying to provide health care a scientist and a young person in social media what i've observed is that i think the biggest impact can be had from empowering individuals with knowledge about metabolic health and finding innovative ways to fund groundbreaking research that is not going to come from normal channels i'm not going to get a million dollars from the nih study i want to do um and and i've seen people try to change the system from the inside
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
without major success. So what I've decided I want to do is try to, after graduation, scale up the early efforts that I've been making with respect to social media education, metabolic health education at a grander scale. The last year for me, starting around New Year's 2024, was experimenting with how people responded to
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
to some of my communications kind of in my free time on the side of medical school. And I think the response has been tremendous publicly, but also on the back end, it has been really incredible to hear from certain parties who are interested in say giving $5 million for a particular trial because metabolic health is touching so many people's lives.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Some people have resources and they'll support you. So for me, it's about finding a way going forward to stimulate conversations get research funded and put people's data in their own hands, knowledge in their own hands so they can start their health journey today while the system as a whole, hopefully slowly changes. Yeah. Yeah.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
a romantic mood setter so you just let those things drift away and for me it continued to get worse and worse after graduation i went to oxford to do my phd and that's when the hit the fan pardon the pun almost probably literally did i i started having these terrible flares and ending up in and out of the hospital yeah i see you down to like 90 pounds right i'll care at some points i was under 100 pounds i was
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
The Buzuki family, they've been very nice to me. And yeah, they're a great example of someone who You know, I would never wish bipolar disorder on Matt Pazuki. However, it's just like I'd never wish ulcerative colitis on me. But sometimes misfortune strikes the right group of people in order to build a highly motivated army to make change.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And I think that's what's happening with metabolic health, and that's why I'm so...
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
optimistic is because on the one hand it's a david and goliath scenario where big pharma the current medical infrastructure biomedical infrastructure like the incentive structure business models are set up to favor pills and procedures yeah and an unhealthy food environment however there is a growing group of people who are just finding incredible success with metabolic health approaches and then
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
unionizing and coming together with albeit you know individually maybe fewer resources a purpose that is so powerful i can't imagine things don't change dramatically but they're only going to do so if we really lean into it and so that's what i'm committing myself to it's not because i don't think western medicine has this place that i don't think it's important it's that because over the past year or so when i'm sitting in that intern room doing my intern level tasks
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
It's not that I don't care about the patient, but my mind is not there. My mind is how can I communicate this incredible scientific story about nanotubes in the brain or cyanide being produced by our lysosomes or whatever to the general public to excite them. Metabolic health, this incredible thing, my mind just wasn't in the clinical medicine.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And so I thought that wasn't fair for me, the patients who, or whatever, you know, a member of my cohort, my peers would otherwise have that position in residency that I'm going to try doing something different because it's where my story, my skillset, my passion, and my skills are most geared where I genuinely think I can have the biggest impact. And maybe I'll fall on my face, but I have to try.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Thank you. I feel like I'm definitely standing on the shoulder of giants and just so excited for the future to come. One thing I will say that will hopefully bring listeners and you some more positive vibes, let's say, is like, I've been feeling out just kind of naturally the interest in metabolic health among my generation of future healthcare leaders. And it's incredible.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
It's like people see, my peers see, our system is screwed up. Medicine has changed for the worse, that patients are suffering, and we are not stepping up as a system to help them enough, and they're looking for innovative solutions. And so I have found my peers to be so receptive to the metabolic health message.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Actually, I was so concerned about this that before I started at Harvard, I wrote a piece for Stat News that was, will a ketogenic diet make me a pariah in medical school? And what I found to be the case is behind closed doors, like people are so open to these fascinating innovations in metabolic health.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So malnourished, my heart rate was hitting like, you know, getting to the 20s. I had gone in the period of a couple years from, apologies for patting myself on the back, but this was the reality. I was a top performing academic, valedictorian at my college, sub three marathoner, breaking like state pushup records to being so successful.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So I guess the challenge set forth before me, and I present this not as a, I'm not trying to toot my own horn for what's coming up. For me, I'm actually asking for help from everybody listening. which is that we've gone through a lot in this podcast.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I'm sure all of you listening caught moments when Mark pulled me back and was like, let's simplify this because you're going off the deep end a little bit. Clearly, I have a lot of enthusiasm for this. And I... want to find a way to engage people in the discussion in the way that is practical, functional, nuanced, and I want to scale the discussion.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And one of the big challenges there that I think everybody who's a public communicator grapples with, I'm sure you've grappled with it over the years, is how do you compete in this ecosystem of engagement bait in a way that is practical and intellectually honest. I think I've really struggled with this because- You've done a great job, honestly, better than most.
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Well, it's difficult because it's like, I know exactly what I'm doing when I eat Oreo cookies to lower my cholesterol. I know the media is going to run with it and say, Harvard doctor, Harvard scientist lowers his cholesterol with Oreo cookies. And I know that's going to create confusion.
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I also know that a similar thing's gonna happen when I do 720 eggs, or that it's kinda clickbaity for me to do debunked with my picture next to a giant ribeye steak when I'm debunking egg carnivore myths. That said, I don't really see another way to access people unless you provide them engagement bait that then draws them to the table to have nuanced discussions.
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So using Oreo cookie as a case in point,
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Yeah, but I'm very transparent about it. In fact, in some of my videos, I say, this is clickbait. Let's see how it does. Here's how I engineered this clickbait. But here's why I'm doing it. And so to use Oreo cookies as a case in point, because I was very nervous about doing that. I didn't just do it on a whim. I'm like, well, this had a net positive or net negative effect.
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I genuinely didn't know.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Oh, definitely talking about my health. I wasn't even worried about my career. I was talking about like public impact. I'm like, I really can't see a scenario where someone genuinely believes Oreo cookies are a health food. I don't think like an adult could be persuaded by a thumbnail. And if they can, then, you know, natural selection can thank me. But that's another question.
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But what resulted was really exactly what I'd hoped and more, which was it drew forth conversations that were incredibly productive. It drew into the fold researchers who were prior, previously not aware of the work, who then started digging down the rabbit hole and finding there's legitimate research here and then investing funds Potentially in big studies in doing so.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
braille that getting up and going to the bathroom costs more energy than running sub three marathons used to. And on top of that, you know, my sub three hour marathon. So that's a pretty good feat. Yeah. I mean, I'm a pretty intense person. Really?
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We have one $2 million project I want to get up and running either later this year or next year to like rigorously assess some of our work in multiomics. And it acts as clinicians. To the point that in the months following the Oreo experiment, I was literally getting emails from cardiologists left and right saying, I saw your Oreo study.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
It put me on a path to learning about lean mass type responders and lipid energy model. I realized I had a bunch of these in my practice. Some of them were statin intolerant, and I've dropped their LDL by 400 points with sweet potatoes because I understand the physiology. So if anything, it had a, quote, positive clinical impact, if anything.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
i bring this up because it's it's hard i'm sure you know it's hard to like put something out there that you know is a is actually i'm going to say a little bit is is clickbaity for the purposes of drawing people into discussion and also knowing that there's going to be collateral damage there's always collateral damage someone's going to be confused somebody's going to be angry and you just accept that and i feel like at a point you just need to there's going to be haters and there's going to be lovers and it doesn't matter who you are what you say
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
You kind of have to start enjoying it a little bit. Start playing with it a little bit. I don't know. I had a couple pieces recently about Diet Coke, aspartame, and both cardiovascular health and reproductive health. And you'd be surprised at how vitriolic people get about their diet.
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I think there is. I will probably never drink a Diet Coke again.
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I think it's first important to acknowledge getting rid of artificial sweeteners, in particular, like say like aspartame and sucralose, costs you nothing. Like you like the taste, but it's not like saying cut out red meat or something that might have a health benefit. There is no clear health benefits.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
is one of the funny things I did. Yeah, when I get my mind on something, I never stopped 2014 Boston Marathon. This was the year after the terrorist bombings, and I'd always wanted to do the Boston Marathon. So I qualified doing a sub three when I was 17, which actually made me the youngest time qualifier for the 2014 marathon.
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You're not eating less calories, though, unless you have the binary of it's a Coke or a Diet Coke. And I hate that binary. People are like, is it worse than a Coke? I'm like, why are you choosing between these two things? Right. Like, if that's actually your binary.
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Then you can choose the lesser of two evils. That is a legitimate choice. Yeah. And my thing is not to say people shouldn't have Diet Coke. It is, here are the data. Make an informed decision like a freaking adult. If you want to slam Oreo cookies and eat milkshakes for the rest of your life- So what is the data?
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So what I would say is there are really interesting data showing potential high-impact harms, like transgenerationally inheritable anxiety. So there's a paper in PNAS, ironic because it sounds like penis, but it was an animal model paper, mice, and I'll explain why that is totally legitimate in a moment, but where they fed mice the equivalent of two to four Diet Cokes for humans in aspartame.
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not only did it generate anxiety on behaviorally validated tests, but it was a transgenerational effect. So the offspring of the mice, and even the grand offspring... To epigenetic effects. Yeah, presumably.
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So past, in this case, we're looking at the male lineage, but there was anxiety in the offspring and the grand offspring, even though they'd never been exposed to low-dose aspartame because their fathers and grandfathers had been exposed. So, you know, and...
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There's, you know, physiologic explanations for how this might work, how aspartame also might affect brain health, how it's breaking down, how it changes amino acid transport to the brain. We can get all that. And also human data on, quote, say, irritability, including randomized controlled trials. So there's some signal in the human literature, for sure.
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It's not the most rigorous of all time study, but then very concerning things in the preclinical literature. And the thing that people tend to do, the Diet Coke defenders, like a perverse Avengers or something, they tend to do is they put up a very implausible bar of evidence. So let's take the example of this study, this PNAS study.
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What it's saying is in mammals, low-dose aspartame, the equivalent to what the FDA says is totally fine, it's like seven to 15% what the FDA says is okay, two to four eight ounce Diet Cokes can cause anxiety that is trans-generationally inheritable. You can ask, well, oh, prove this in humans.
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But if you look at my time for the 2014 marathon, it was just under seven hours. And that's because I ended up breaking my tibia right before the race. So I did the whole marathon on crutches. Wow. Which I had to get special permission to do anyway. Back to Oxford. Yeah, no, I was my quality of life had been completely destroyed.
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I'm like, you're really gonna try to do a 50 to 60 year randomized controlled trial where you give human adults Diet Coke and then track, it's never gonna be done. And so you're asking for evidence that can't be collected. And I'm not saying the evidence is entirely watertight. So another paper just came out, and I think it was Cell Metabolism, on aspartame and cardiovascular disease.
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And what they showed in mice, and also they had some monkey data, was that it can spike glucose and insulin. And what this did was increased plaque progression in susceptible mice, admittedly susceptible mice. However, the mechanism had to do with increasing certain molecules on the endothelial lining.
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Basically, there were like baseball gloves for rolling around immune cells, the baseball that sucked them into the arterial lining and caused plaque to grow.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So there is a very clear physiological model with data in mice and primates showing how this could negatively impact heart health in conjunction with associational data saying artificial sweetener intake is associated with cardiovascular disease. Does this prove beyond a shadow of a doubt that diacocardial heart disease?
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No, but you shouldn't need those data to incorporate the existing literature, which is of concern into your individual algorithm of whether or not you want to make the decision. So, and artificial sweeteners, to be clear, in humans have been shown to cause insulin resistance. Sometimes it takes longer than a day or so.
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There was one study out of the Weizmann Institute, I think it was Nature, where they showed that it was saccharin in this case caused insulin resistance by changing the microbiome. In this case, it was a majority, but not all people had a response. There might be individualistic elements. It may take time to result. The data are not
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absolutely proven without a shadow of a doubt, but there's enough there to say, this is concerning. And then the question is, where do you put the burden of proof? Is the burden of proof defined the implausible study that proves it without a shadow of a doubt? Or can you just say, you know, these literature are concerning enough for me to be like, I might be okay with freaking water.
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I was barely staying afloat with my studies, doing a lot of my work from the hospital. No social life, no romantic social life, really just had nothing beyond what was on paper for me.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
It's funny because you actually hit on a broader point about this burden of proof. Because if you don't have evidence to say this is very harmful, and sometimes the harms manifest over a long period of time, then should you be allowed to introduce a substance into the food supply? And the fact of the matter is right now, the way it is, the answer is you are allowed. You are allowed, yeah.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And then after the fact, we might do some assessment.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And so let's say, just playing with random numbers here, there's only a one in 100 chance that any given chemical actually that is not proven to be safe over a long period of time is harmful. Well, if you introduce 10,000 chemicals... And they're all synergistic. Right. And so we see that with a lot of things. My position is we do live in a society of free choice. So I'm not for...
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
restriction of most things and more about better education. So I think we can talk about these things. I don't think Diet Coke should be outlawed.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Have you seen some of the coffees at Starbucks?
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Again, informed choice. If you want sweet and say you're like, you know, you want sweet without calories, there are better options than aspartame or sucralose. I think you're going to have say monk fruit, stevia, I think are like totally fine. Allulose, I think totally fine. So it's a matter of making an informed choice. In this particular case, I think the sacrifice is basically negligible.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
That said, if you want to have a Diet Coke, just understand and appreciate the data. Don't stick your head in the sand because the impact is potentially large. Genuinely, and this is going to sound hyperbolic, but I mean this sincerely, like say you're trying to conceive with your partner. You're a guy, you're producing more sperm every day. Is it worth it to you? Read this PNS paper if you want.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
It's linked on a YouTube video that
The Dr. Hyman Show
Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
uh all put out no and make anxious sperm so don't do it i know it's uh yeah anxious sperm is it worth it to you to risk a potential impact on the mental health of your future children which you'll never know for sure say they develop anxiety you'll never know if it was your fault or not you will never know but is it worth it to you to have those two diet cokes per day is it yeah and i would say it's just like for me no if if it really matters to you that much
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If you're an individual, you can make an adult decision. If you're a kid, it's not mine.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Well, that's the great irony is you think I'm in a ketone lab and then I start a ketogenic diet. Somebody might intuit like, oh, he was informed by his studies. That's not at all what happened.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I love that. My karate sensei and I got matching stay curious tattoos. I love that.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So I had read a beautiful paper by Cox et al and Sell in 2017 about exercise metabolism as an undergrad from this lab in Oxford using exogenous ketones, this ketone ester that had been developed using a grant from DARPA, US military, some like super soldier project to enhance athletic performance. and cognitive performance.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
So I was just drawn to actually the possible physical performance boosting effects and just metabolism and physiology. So I went to this lab because I found the work just really fascinating, using the tool as a supplement, completely separate from the diet. At that time, starting at Oxford using ketone esters, I still had a very negative view of the diet. My PI actually did as well.
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Her name was Kieran Clark. Keto diet was still in my shit list, I guess you could say. or I had a very negative perception of it. Like I think a lot of people do based on what you see in the media around ketogenic diets and what I had internalized through growing up as a kid in the late 90s and early 2000s, really about what healthy is.
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And I just could not conceive of a world where a high fat, very low carbohydrate diet was a healthy diet.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Yeah, yeah. So I had a very negative perception of it. Now, how I ultimately found my way to it is after a couple of years of trying standard therapy for ulcerative colitis, I just, I wasn't getting better.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
All the regular stuff, you know, first line therapies and then steroids for flares. And, you know, like I'd exit a flare and go into remission and then I just relapsed. which is obviously incredibly frustrating. It was just tearing at me from the inside. I just, I couldn't be a reliable person.
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I couldn't say yes to offers that I wanted to say yes to because I just didn't know what would happen to me. I got very desperate and I started experimenting with things. I didn't think diet would help, but I had nothing to lose. So I started experimenting with diet because, you know, on a superficial level.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I tried paleo, I tried Mediterranean, I tried vegan, I tried, you know, pescatarian. Anything you can imagine, I've probably tried, along with the standard things like low FODMAP, specific carbohydrate. And I'd try them pretty rigorously for like a month or so. And then eventually I came to a ketogenic diet. And I just thought I'd try it because what the heck.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
And what happened for me was my inflammatory markers dropped to the lowest they'd been. My disease started. I started feeling so much better, getting my energy back, getting my mind back. And then the next time I got a colonoscopy, I was in biopsy for permission. which was stunning. And I was forced to reconcile with the fact that this was my lived experience.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
This has been my lived experience, despite the fact that it's not a quote, evidence-based approach. So a lot of what I've been thinking about with respect to metabolic health- The absence of evidence is not the evidence of absence.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
But I'd heard that saying before starting medical school, but it really didn't sink in until I started to think about our current biomedical infrastructure business models around health. and why certain interventions would or would not be explored.
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Right, so it hasn't been properly explored and which makes it, to me, the low-hanging fruit for treating all these chronic metabolic diseases, which we have been poorly equipped to address. Cardiovascular disease, inflammatory bowel disease, obesity, diabetes.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Mental health issues as well.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Is it Shabani Sethi? Yeah. Yeah.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I've done a little bit of work with her, Chris Palmer, Suzuki Group, Metabolic Mind. The universe of things that we could treat with rigorous metabolic therapies is truly impressive. But in order to make that standard of care, we need to grapple with the fact that they're not by conventional metrics currently, quote, evidence-based.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
because there isn't the research and funding infrastructure to do these trials with the same degree of, quote, rigor as pharmaceuticals. Because again, the business model isn't as clear. It's very clear if you produce a pill and it treats a disease, you can sell that drug and make a massive profit, even if The drug doesn't help most people.
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You can get a statistically significant result in a trial that you publish in the New England Journal, and it can still help only a minority of people.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I think the top 10 drugs only help like 1 to 4 to 1 in 10 people who take them.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I think the first thing to acknowledge is there's not a good definition of metabolic health. When we're talking about scientific communication, there are some terms that have very strict definitions and criteria and other terms that are more like Porn, where you know it when you see it. Another example would be ultra-processed foods.
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Really defining that scientifically is difficult, but it's a useful term and heuristic in the public sphere. So I'll just say up front, I feel like metabolic health is similar where it encompasses a lot of things and there's a lot of definitions, but I just want to be up front. There is no consensus on what the definition is. With that said, there are different ways to slice it.
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The way I like to think about it is it's when your body's systems are running in a way to optimize performance and minimize risk of chronic disease. You can start to intuit that through certain biomarkers. So there's like canaries in the coal mine for poor metabolic health. Like if you have high fasting insulin or insulin resistance score,
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
Things like triglyceride to HDL ratio or, you know, features of metabolic syndrome. You look at your waist circumference, your visceral fat. There's a lot of things you can look at.
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Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz
I think a way to think about it is, I don't know if I came up with this analogy, I can't imagine I did, but that of the tree of metabolic illness, where, you know, if you look at a tree and you look at all the different branches, you can see each different branch of the disease, obesity, diabetes, cardiovascular disease.