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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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
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?
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,
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.
Mine's like 500, 550. And we can get into the saturated fat or something later.
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.
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...
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
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
And so I'm like, I want to engineer something that...
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
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