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.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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?
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.
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.
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.
I don't think it's catastrophically high.
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.
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.
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...
Showing 281–300 of 450 · page 15 of 23
← Previous
Next →