Nick Norwitz
speaker
450 appearances
2 recordings
2 series
first heard Apr 2025
last heard Apr 2025
Nick Norwitz’s voice in public audio — every appearance, attributed to the second.
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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.
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.
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.
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.
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...
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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