Oreo Cookies Are Better Than Statins? | Dr. Nick Norwitz

what's driving up the LDL then what's the mechanism here and of course what are the implications for risk people who are leaner tend to have the increases in LDL so if you go do the randomized control trials in lean people so normal BMI under 25 there is an increase in LDL you look at rcts on people with overweight or obesity class one no increase obesity Class 2 you actually see a decrease welcome to the plant-free MD podcast with Dr Anthony chaffy where we discuss diet and nutrition and how this affects health and chronic disease and show you how you can use this to optimize your health and happiness both mentally and physically hello everyone thank you for joining another episode of the plant- free MD I'm your host Dr Anthony chaffy and today have very special guest Dr Nick norwitz who is uh who's kind enough to join us in the middle of his studies over at uh Harvard Medical School Nick thank you so much for joining thanks for having me oh you're very welcome so for people that don't know uh who you are haven't come across your work before can you tell us a bit about you sure um I'm a relatively new face to the space um I am born and bred in uh New England I grew up in Boston and Connecticut for a while I went to Dartmouth College where I studied cell bio and biocam and as I was finishing on my undergrad studies started to develop some issues with inflammatory bowel disease specifically ORD colitis after college I went across the pond to um Oxford to do my PhD in human metabolism and around that time I was having some more Health troubles as well with the IBD ended up getting quite sick um and long story short like a lot of people out of desperation tried a ketogenic diet and actually found it was incredibly effective for my IBD the only thing that really worked well my um symptoms went away my inflammatory markers went down and even years later on biopsy testing there's no sign of disease so um that was my uh let's say bait into the metabolic Health low carb space and ever since then I've been delving into the uh communities and the research and just really been taken in a New Direction with respect to my let's say career trajectory and purpose uh I finished up my PhD and then came back across the pond to do medical school at Harvard so I'm now in my U third year so one year from completing the whole mdphd quest in Saga it's a long span of time and over the past couple years I've just been really engaged in the research it's kind of a pretty special place and time and I feel very privileged to have access through social media to so many cool and interesting people to be able to come on podcast and talk about the work I'm doing while also be able you know being able to access the resources that are provided by the academic institutions that I'm at so it's pretty cool networking opportunity and um I'm really exciting to be it's exciting to be starting my my career and have um all this uh fun data uh to delve into specifically with respect to a phenotype that we've been studying for a while and I guess that's going to be the topic of our discussion which is lean mass hyperresponders people who see these massive increases in cholesterol when they go low carb like myself so that's where we are and that's who I am yeah absolutely so how did you get involved with the lean mass hyperr uh sort of research yeah so um for those who don't know the story it was uh the the concept and the term was coined by Dave Felman who's a software engineer in 2015 he went keto no noticed his LDL skyrocketed and over a period of years he was noticing huh the people that are seeing these increases in the LDL quote bad cholesterol actually tend to be the ones who are lean and pretty healthy that's kind of weird so we came up with this uh this phenotype which he turned tered lean mass hyperresponders which actually by definition has nothing no criteria for leanness it's a Triad of marker so high LDL above 200 High HDL above 80 and low triglycerides below 70 now people ask why these cut points well each one is pretty rare alone to have them coincide it would be very unlikely by chance making us think it's kind of part of a pattern so it's kind of like if you roll a dice 100 sided dice three times what's the chance you're going to get the same number on every roll very very low in the general population so when they do occur we think it you know probably um part of a pattern so he first observed this put together those uh criteria and over the span of uh years had been acquiring let's just say some generals to his army and in 2019 which is when I went keto I observed the same thing where my elel went from the 90s to the 300s and then to the 500s when I went keto um at the time was was very lean and it was very shocking to me especially with you know um a family with a medical background going to medical school I kind of knew what the implications of having an LDL of 400 500 were and it's pretty shocking so it makes you you know provoked in studying it and then you become very engrossed as a scientist when you realize well this is a weird pattern like what's up here and you you when you have the resources want to study it and we're finding these very interesting associations like the fact that it's true it turns out that the main driver of high LDL when you're low carb is actually lower BMI being leaner um not the saturated fat in fact um we recently had a paper accepted at a um a major journal that was a meta analysis of randomized control trials by the time this episode drops it will probably out be out so it was accepted on um January 12th which is when we're recording I don't know when the episode will drop but the paper should be out and what it shows is that um you know people who are leaner tend to have the increases in LDL so if you go do the randomized control trials in lean people so normal BMI under 25 there is an increase in LDL you look at rcts on people with overweight or obesity class one no increase obesity Class 2 you actually see a decrease and if you look at the saturated fat data um in comparison the effect is pretty minimal so this counters the common knowledge narrative that oh people are just seeing increases in LDL because they're guzzling butter turns out probably not the butter with the six-pack which is actually pretty cool and interesting so that begs the question well what's driving up the lzl then what's the mechanism here and of course what are the implications for risk which are two separate questions that were um in the process of investigating each of them yeah very interesting and so those those would presumably go by BMI as opposed to like body fat percentage I'm in I'm in the obese category have pretty low um body fat percentage but I I respond in the same way so my LDL shot up as well it's just about what data we have access to so if we're doing a cohort study on several hundred people we have BMI data we don't have dexas on everybody so it's a limitation of literature we did actually have body comp data on an Interventional trial that was run by first author Dr Isabella Cooper um and what we found was that the fat-free mass and fat Mass also were predictive so if I had to guess I would guess yeah we could get much better predictions with dexas on everybody it's just we don't have um that tier of data quite yet so we use BMI as a poor man's proxy yeah yeah it's just a sort of yeah it's probably leanness to it yeah it's the leanness so yeah I think that it would be ideal not to have to use a BMI cut off and use a body fat percentage I mean there are a lot of things that go into lipid energy model um including your you know body habitus probably you know your lean mass your energy expenditure things like that so obviously BMI is an oversimplification but in terms of looking at Broad populations you know it's it's what we have at the current moment but yeah if you want my speculation I would say I'd much rather have comprehensive you know uh dexa Imaging on everybody know your visceral fat subq lean muscle mass and we could probably get more data out of that but we don't have that on big populations yet so we're stuck with what we got yeah very difficult so so people haven't come across it you can you explain a bit about the lipid energy model yeah so the um 50,000 ft view is when you shift from carb burning to fat burning and you're very lean you need to upregulate the system that traffics fat fuel around the body and specifically what happens is when the um liver glycogen stores the liver carb stores go down what happens is there are very high levels of free fat fatty acid circulating around they go back to the liver get packaged into triglycerides those triglycerides get put aboard these very low density lipo protein particles these big spheres that are packed in with triglycerides those get sent out of the liver at a very high rate we think but at a commensurate very high rate there's very quick turnover of these big L vldl particles the triglycerides get sucked out put into your muscle tissues to get burned or into your fat cells to replenish the fat cells and so the tricer go down quite a lot because they're getting sucked straight out of the vldl and what happens when you take this big vldl sphere you suck the triglycerides out what you're end up what you end up with is the next step in that lineage which is the LDL the vldl gets turned into the LDL as the triglycerides go down so those are two parts of the Triad your LDL goes up with the quick turnover the LDL has a much longer Half-Life than the vldl and then the Triads go down because they're getting sucked out into muscle and fat tissue the last part of the Triad is the HDL cholesterol and actually um part of the turnover process where that vldl is being shrunk down into the LDL generates an increase in HDL cholesterol because the surface of the vldl right you take a sphere and you're shrinking it down you're not just decreasing the volume inside but the surface area and there are you know when the surface kind of it's not exactly bling but comes off it needs to be picked up by an acceptor particle cholesterol comes off from the surface and it's picked up by HDL appoa particles and so the HDL cholesterol fraction goes up and so then you end up with this Triad of high LDL High HDL and low triglycerides and it becomes more extreme the leaner you are and the higher your activity level so in somebody who's say very lean and very active and very low carb you can see levels that are extraordinarily high with ldls as high as 500 600 um and so that's the basics of the model and it's useful in that it makes particular predictions that we can test so adding back carbs should reverse the phenotype um changing your activity level should reverse the phenotype so all things being equal if you could control all other variables somebody who you know increases their cardio their LDL might go up this is actually a subexperiment of one experiment I did which we're going to talk about where I saw exactly that so um it's a cool model and it's very easily predict or it makes clear predictions that we can chase up and study so I I do have to give of course a hat to to the um father of the model who was Dave Felman he came up with it originally and we've been developing it for some time so we published on it in 2022 I was going to say last year but I guess it was two years ago and um have you know set out a set of wishless experiments that we want to do to kind of Chase up on the model see how generalizable this phenotype is but it's very exciting because it make such bold predictions that we can test and I think has a ton to teach us about human physiology and lipid metabol ISM so um I think you know the core of our conversation today is going to be one particularly extreme experiment that I pulled to test lipid energy model yeah absolutely yeah so so on that note yeah what was this uh this experiment that you you ran yeah so for a little bit of context like I I mentioned the the data on this topic has been evolving quite rapidly um we have closing on on 10 papers that have been published or accepted um some pretty robust studies including meta analyses of rcts so I think that the data is growing or the data are growing but it's such a controversial topic that's a whole another conversation as to why which I still can't really wrap my head around against about why there's so much push back and in Dogma in this space nevertheless there are people that really want to avoid talking about lean mass hyper responders suppress the discussion so I did something that I'm hoping will shove it in everybody's faces and make it impossible to ignore yeah um so you know productive provocation I'll call it or legit bait this is something that I'm very in it's very intentionally meant to provoke turn heads call it clickbait if you want but it's a legitimate scientific experiment so prediction of the lipid energy model adding back carbs will lower cholesterol in a lean mass will any carbs work will a pure addition work and how to carbs any carbs even bad carbs compare to you know standard of care Statin therapy so I went as the kids including myself say nowadays full send and um designed a study whereby I'd compare consuming Oreo cookies to high-intensity Statin therapy for LTL lowering that was the question and the hypothesis would be that Oreo cookies might perform equal to or maybe even better than a Statin in a lean mass hyperr because adding back carbs will remove the driving force behind the lipid energy model so what I did was I designed the study with input from a consultant cardiologist and lipidologist I went and got the appr appropriate IRB exemptions from Harvard which you know they granted me the proper exemptions I got my PCP on board she was ordering all the tests they went straight into the electronic medical record I can't f take this um and had her monitoring along with my consultant lipidologist so did everything by the books above board and announc the protocol a priori um actually on a prominent um vegans podcast plant Chompers the host is Chris mcast really lovely guy but you can see the episode where where I announc it saying look I'm doing this I'm putting the protocol out there so you know I'm um embarking on this journey and then we'll see what the data show the results came in and I won't bury the lead any further the Oreo cookies were more than twice as potent as the Statin and lowering the LDL the Oreo cookies actually kicked Statin butt at lowering my LDL so that's your clickbait that's the headline um the specific numbers were in 16 days 12 Oreo cookies per day lowered my LDL by 71% from 384 milligram per deciliter to 111 that was in 16 days as compared to the Statin which I took for six weeks and the lowest drop in my LDL was only 32.5% 32.5 for the Statin as compared to 71% for the cookies so the cookies were twice as effective the absolute drop for the Staten was at its ner 421 to 284 milligrams per de liter so 137 so yeah the cookies were more effective in me which obviously raises some uncomfortable questions and that was the intention and you know it's for me looking at lean mass hyper responders and lipid energy model I am just stunned every day by how cool and interesting it is but I realize that's a difficult thing to translate to shock and awe for your average person so the goal of this was to do exactly that take the shock and awe that I feel for studying this topic and translate to something that everybody can see and go wait what just happened and then ask questions about why because this is you know it's provocative but it's freaking cool and if it doesn't ask you to you know if it doesn't provoke you to ask more questions you should just hand in your scientist card now because this is this is fascinating even if it is you know a unique population lean mass hyperresponders you have to be provoked into asking wow how does this work and um so it's it's something that is really meant to turn heads get people looking at the lipid energy model and engaging with the science around this topic so you know I'm defin definitely throwing a social media and media grenade out there with the potential headlines that might be running Harvard scientist medical student lowers his cholesterol with Oreo cookies Oreo cookies more potent than Statin at lowering cholesterol in a medical student X Y and Z we'll see if I can control the narrative or if it gets away from me I'm not even really sure if that will be the case this might have been an unwise decision nevertheless here's where we are I'm expecting a release of the paper in a week or to and it's going to be a really interesting journey to see how everybody responds again I'm not hiding the fact that this is very intentionally meant to be provocative but provocative with a productive Bend because it's a cool observation and I want people asking me questions and asking you know in the medical community coming together around this and saying well what's up let's study this further let's invest resources into figuring out what's going on with the lipid energy model Le Mass hyper responders so that's where we are that's what I did yeah well that was that was great and when when I heard about that that that sort of just snarky sort of just like you know I'm going to do this with Oreo cookies and you know please try and say that Oreo cookies are good for your heart I absolutely love that and you know I think it's I think it's great to because if you did with bananas if you did it with bread there's always going to be some excuse well you know this could be good for these Oreo cookies you you I I would love to see anyone argue that Oreo cookies are a benefit to your heart and so that's I great choice we'll we'll see how it goes down because the criticisms I've already gotten are you're going to mislead people into thinking Oreos are healthy my immediate response and I have actually a slide maybe I'll change it for the metabolic Health Summit but I'm like this is the the response and then I have like a um a gift come up and it's like really like that's your criticism you really think people are going to think Oreos are healthy I hope they're wrong I I kind of went forward going going with this being like I think I have like I can presume some like basic human common you know Common logic and knowledge I hope I can assume that I hope people really don't think Oreos are healthy I put all the caveats in I mean it even says in the graphical abstract this is a metabolic demonstration I say in the video do not do this at home like clarify Oreos are not a health food so I don't think people will be misled but that's the point the point is you have to Grapple with the tension and and the cognitive dissonance of the fact that this is clearly not a healthy thing to do and yet we see what is presumed to be a healthy response so what do you do with those two pieces of information how do you resolve that and I'm not here to resolve that for you I'm here to put the question in front of you and say this is what you have to Grapple with now let's grapple with it yeah well I certainly don't think your study is going to be uh misleading to people however you know the Oreo cookie company might be like hey hey Oreo cookies drop LDL and they run that with their headline clinically proven by Oxford PhD to lower your lower LDL you know we'll see I mean um well I I'll tell you I won't be accepting any sponsorship money from Oreo no but uh yeah I like I said I'm playing with fire a little bit I'm very aware of that um and I'm gonna be reflective on how this actually goes down is there a universe in which this really gets out of hand and I have have a net negative effect and I regret doing this yeah that could happen I mean that's hindsight 2020 I don't know what going to happen like I said I Tred to do this in as a responsible manner as possible went to the IRB got my PCP on board consultant cardiologist you know I've been very above board with my messaging and trying to be clear if this gets out of hand I will be the first to apologize I don't think it will though I my my impression is it'll my best guess is it'll have a net positive in uh impact on just directing attention to this phenotype and engaging people with science the really cool thing about living in this day and age is you know the general public has so much access to information through the internet and through social media and yeah there are bad aspects to that but there are also really excellent aspects where you see citizen scientists engaging with the scientific process and for me as a scientist and a scientif communicator there's something really special about being able to translate something that I find really cool into something that other people find really cool and getting them interested in science Andrew huberman always says thank you for your interest in science and I really love the spirit of that being able to translate what what we as academics love into something that other people can engage with and think about and I've really found even through just my new social media and YouTube presence that people are really smart when you give them a chance and you sit down and explain things to them and know I can't tell you the number of comments on my YouTube videos that are like this is so cool I love learning about this and it literally can be something like you know I I go through a mechanism where oh you know intracellular fructose is acted upon by ketohexokinase that depletes ATP amp gets acted upon by damase 2 to make uric acid causes translocation of nadph oxidates forward to the mitochondria damages a con citas builds up causes you know increase in noval lipogenesis go through all that mechanism but in you know a stepbystep manner where your average person can actually understand it and go like wow I didn't think about biology like that yeah and and that's a pretty cool thing to be able to translate and sometimes I feel like you do need a dramatic metabolic demonstration or dramatic demonstration of sorts in in order to engage people I mean the obvious analogy is like a clickbait thumbnail it's just you have to deal with that currency a little bit in this space and you can back it with nuance and science walking that line is something I'm still figuring out how to do but it's a reality that you do you do have to engage people somehow so this is one way to do that and another benefit to this approach as well so just engaging people in science hey guys just want to take a second to thank our sponsor carnivore bar I don't promote many products because honestly all you need to be healthy is to just eat meat for those times that you're out hiking road tripping or stuck at work and you want nutritious snack that is just meat fat and salt if you want it the carnival bar is a great option so I like this product not because it's just pure meat but also because I want the Carn Market to thrive as well and the more we support meat only products the more meat only products there will be available in the mainstream so if this sounds like something you'd like to get behind check it out using my discount code Anthony to get 10% off which also applies to subscriptions giving you 25% off total all right thanks guys yeah well it it also gets rid of a few confounders right because if you picked another carbohydrate Source people would say well you know but that's healthy for these reasons and there's really no question that Oreo cookies are not good for you and I and I hope that they try to run with that narrative that oh this proves Oreo cookies are great for you but I think it I think it's it's a good demonstration that LDL is not absolute you know that that you know that lowering LDL raising LDL that's not necessarily A a net positive or or negative um and like you said you know you're just putting this out there and you're letting other people contend with with the meaning of that and maybe open up you know the the the channel for other um studies you know one one study that came to mind when you said that was a study that they did on the Inuit up in Northern Canada in the 1990s throughout the 20th century the innuit population had extremely low rates of chronic disease cancer heart disease and so on in fact next to nothing in the early 20th century and it slowly started increasing as you go which you know if you would think about it that's when they're becoming more westernized more access to Western food they start smoking yeah I think statistic want that they start smoking as early as 8 years old sometimes and by the 1990s they still had extremely low levels of heart disease even as you know as compared to the rest of Canada and they said okay well these guys have horrible lifestyle you know this is this is full in the full force um you know cholesterol theory of of heart disease you know was in full force in the 90s and they're just eating blubber and they're smoking as eight-year-olds right so they're like these they have super high risk but they have low rates of disease they probably have genetic protections they're they're genetically uh you know adapted to living in this environment and being protected against heart disease that was the theory so they went and they checked them for a number of different genetic markers that would predispose them or protect them from heart disease and they found that they had all the bad ones they had all the things that basically increased their risk of heart disease so they were not genetically protected against heart disease and the conclusion was we have no idea what the hell is going on um we don't know if there's something else going on that's protecting ing them you know they have all these horrible risk factors or maybe it's just these genetic markers are just not all they're cracked up to be maybe they're not as predictive as we thought so they just sort of went we have no idea which really would I think beg the question well maybe the premise is wrong maybe the premise that eating fatty meat causes heart disease is wrong if you see clear evidence to the contrary these people are genetically predisposed to getting heart disease or at least not protected against heart disease and that's the thing if you look from an evolutionary standpoint they aren't the they they aren't the adaptations they didn't adapt to living in an ice age we all came from Ice Ages Europeans and other populations that have had cultivation for the last 8 to 10,000 years we're the adaptations we had to adapt to a new food source and try to you know make adaptations that would make this less harmful to us you know there's clear distinct drop and decline in our development brain capacity height uh jaw development and uh signs of infectious disease and poor wound healing immediately after agriculture at every point that it was discovered around the world and we saw this in real time in the last 100 years with uh Native Americans and native Australians there was a study in 2001 that showed that the Plains Indians in in North America who were just eating bison in the 1800s in during that time were the tallest population of human beings on Earth Wipe Out the Bison they started eating more Western food now they are not the tallest human beings on Earth and there's that that clear distinct drop they go from a hunter hunter gatherer past really Hunter to a more agrarian uh diet and clear distinct drop in their height and health and now they're far less healthy than the average American eating the same thing doing the same thing so I think it really begs a question um you know is this is this lipid theory of heart disease even accurate yeah I mean I I'm not an evolutionary biologist and I'm not aware of the studies to which you're refer refering I'm not going to comment on them specifically but I think uh the one thing that I heard you say which I'll I'll build upon was the whole we don't know and I think the most important part of the scientific process is to be humble about the boundaries of the unknown and the limitations of our current model which is I think where something like a lean mass hyperr phenotype fits in beautifully because there's clearly something here that we don't appreciate the scope of and the Imp ations of and there are different ways to respond to that and unfortunately what I've seen is a little bit of push back in order to go with the um the common narrative and and the Dogma if you want to use that word which just doesn't go along with what I feel the the spirit of the scientific process is um I can give you one example which I kind of mentioned when we were Offline that was very shocking to me which was an abstract published in a top cardiovascular joural circulation you can see it on my Twitter page I can I can send you a link to uh the tweet and the the video coverage we did over it but basically the title read something to the effect of you know um a subject um stops a Statin and a lean mass hyperr subject so they name our phenotype um stops the Statin goes on a ketogenic diet and develops rapid plaque progression there's clear claim in the title that the ketogenic diet caused rapid coronary plaque progression now again top cardiovascular Journal it was presented at an American Heart Association conference um now it was a case report so when I saw the title I was just like okay they found a patient who had rapid black progression on a keto diet that's not very surprising we have thousands and thousands of people who are lean mass hyper responders of course you're going to be able to find one but then I read the abstract and when I send you the abstract I'm sure your jaw will drop to the floor like mine did because it it just was not at all matched to the title first of all the patient wasn't a lean mass hyper responder they misquote the criteria and even with the misquoted criteria he's still not a lean mass hyper responder so you know they're effectively lying there and then you read the case history and the case history went as follows patient sometime in his past they didn't even say when but had a um a percutaneous coronary intervention so PCI because he had a left anterior descending um obstruction so basically part of his left artery a major branch of his left coronary artery was obstructed this is when he was on a mixed diet to be clear he was not keto but when they went in there to do the intervention presumably stented open they noticed okay we're fixing this artery but we can see in the right artery oh there's already moderate disease in the right artery so they note moderate disease in the right artery probably patch up the Le left artery they stent it open they put them on a Statin then some years pass I'll emphasize then some years pass during which time he's not being monitored for plaque progression and then at some point he tries a ketogenic diet and has an RCA stemi um they don't say what the keto diet was they don't say how long he was on the ketogenic diet they don't have a baseline for his plaque because years to progress since they were in his heart for his pre-exist disease while he was on a mixed diet and nevertheless they try to pin the blame on the rapid plaque progression on the ketogenic diet again look at that timeline a guy with heart disease on a mixed diet presumably on a mixed diet didn't say what his diet was already has disease in his left artery they look in his left artery or the right artery while they're fixing the left artery there's disease there they you know let him then progress for years with medication during which there's no further progression and then he tries a ketogenic diet and has you know more right coronary disease how does that add up to blaming the ketogenic diet for the disease it literally could have been oh he was on statins for a couple years during which disease was progressing then he ate bacon for a week yeah I was the bacon yeah like and then this gets published in a top cardiovascular journal and presented at an aha conference and for the record in addition to responding to it on social media I like to go through the proper channels you know either contact the authors whose emails were not provided or write a letter to the editor which we actually tried to do I had a few cardiologists on board who agreed look this is nonsense and yeah we'll sign on to a letter but because it was an abstract and never went to a full manuscript you can't write a letter to the editor and generally you have e letters where you can reply as well but again it was an abstract on the full manuscript so that option wasn't open so even in emailing the journal I had a um a colleague cardiologist emailed the journal to figure out what are our options for replying in a formal Manner and they basically said said yeah there's nothing really we're just going to let it sit there and then move on so I mean that's just one example I found it like I get people making caricatures out of things on social media to see that published I I still can't fully wrap my head around that level of of bias in literature and you know the peer review process we all know it's flawed it's hard to imagine exactly what an ideal p process would look like but something to understand is it's there are politics involved it is not a meritocracy it is not perfect um and I don't want to be too cynical but there is a degree of gamification and narrative building and double standards which is something that you have to contend with I don't know if I'm contending with it in the best manner possible but you do what you think is right by the science so you know that's also the context in which I'm I'm playing this a provocation game with the experiments I'm doing trying to you know do what I think is right by the science but at the same time play with the tools that are available to craft the scientific narrative because that's all this is there are data and we can talk about the data but people want that translated into a narrative and so that's always is what we're trying to do constantly turn the data into results and conclusions um and that's that's that's a kind of a fun process but it's it's a very interesting ecosystem to be in and um yeah the whole the whole point of this was why I did the the Oro versus Statin study again to really Force discussion about a topic that is being grossly misrepresented one example is you know an abstract like this which you can get into a top journal and it's complete like I'm sorry it's trash I know that's strong language but it was it was a trash abstract so you can read it everybody can read it it's open access I'm pretty sure even without a medical medical degree it's a few paragraphs you can read and be like really this gu published anyway yeah well I uh yeah I've seen that as well obviously in in media well there was there was actually a study out of Columbia that looked it was for media headlines and so things on on the internet um basically people read headline they did a study they sort of had all these headlines and things like that and they tracked how many people actually clicked the link and read the article before commenting on it and saying like they knew everything about this U they found that that something like 52% of people didn't even click the link before commenting and sharing and saying oh look see this proves my point or I think it's wrong because of X Y and Z so it was great yeah it's it's super amusing I'm sure you get this too but like the degree to which people will respond to like a YouTube video or a tweet without with clearly not reading or understanding anything about the context I can get two parallel like tweet comments one calling me like a roided out carnivore magga extremist and the other one's like who is this like vegan leprechaun Statin shill and I'm like do you see these like the ju position here about like how I can be caricaturized and it's just kind of amusing um when it comes to the science it's just people if you don't know what the Dunning kuger effect is go Google it and read it about on Wikipedia but it's basically the phenomenon that you know sometimes people with the least expertise are the most confident in the topic matter and you see that come out in spades on social media how confident people are about their understanding of the science and the medicine and look I I I like the idea in general of people quote doing their own research and being thoughtful but don't be hyper arrogant about your understanding of the biosciences because you know it's freaking complicated and the more you engage in it the more complicated you appreciate it is so you know anyway yeah hum yeah that's always true I I got um a bit uh you know we'll takeen off my eyes years ago reading different studies and you know seeing the headlines seeing their conclusions well this is and some times they'll put the conclusion in the title which is is a bit inappropriate um you know but their their opinion or their editorialization of the data would be in the title and then that just gets shared around and then you actually read the study well you read the abstract it can be one thing but then you actually read the study and the you know their actual results and their methods it really doesn't support the title or the conclusion and that's that's that was pretty Awakening for me and I started um yeah getting a bit worried with that I mean obviously there are more extreme examples like you're saying I mean that that that was just a fraudulent abstract basically um yeah but uh if you don't if you don't know better you know you'll just see that just go oh look at this but it's like you know Russian nesting dolls it can get really nuanced and complex I don't know if you saw our reanalysis of the 2021 nature medicine trial but um there was a 2021 nature medicine trial run out of the ni published in a top journal Nature medicine that was you know the kind of trial that has all the bells and whistles that would make people believe it it was a randomized controlled crossover trial in a metabolic Ward comparing low carb to low fat and the conclusion was that low fat led to less energy intake you know and therefore more fat loss now there were a few problems in that including the fact that there were short-term arms but nevertheless again all the bells and whistles to make people believe it it gets into a top journal and it took a couple years for us to actually look back at it and say hold on this study has a huge fundamental flaw in fact the results are so misleading that they're basically invalid and it came really down to one sentence in the whole paper which was in the methods where it said this is subtle but we looked for diet carryover effects and basically didn't find any and that's something that most people might over look the idea of a diet carryover effect is that one you know intervention one diet the effect bleeds over into the next one so if you have Diet a and diet b a diet B directly follows diet a then if there some adaptation happening during diet a diet a can either pass blame or credit onto diet B so if you have a crossover trial like this then you know and and and diet effects are bleeding over into each other it can create very misleading results which is actually what we found in this paper that diet order had a larger impact than um than the diet itself and that there was a huge advantage of having a low carb diet first it basically primed your metabolism and primed your you know hunger drive to eat less in line with the carbohydrate insulin model which you know we can go into a little bit but the bottom line was when you had low carb first there was positive metabolic priming so that when you went low fat you ate fewer calories whereas if you had low fat first then you were negative met NE negatively metabolically primed end up eating more but when you blend Ed everything together and made low fat look better when in reality it was the positive metabolic priming effects of low carb versus the negative metabolic priming effects of low fat so low fat was passing passing blame onto low carb and low fat was stealing credit from low carb so we break that down in the paper but that's just another example of how you know this can be look like a top you know high quality study published in a top journal and it becomes part of the um the the literature and Zeitgeist and then you look back at it and say wait these results are completely misleading and has let have let us down you know an incorrect path so science is a process and you can make honest mistakes like that but um it's also important to realize that you know probably the scientific literature is littered with a lot of things that are leading Us in incorrect directions and so it's always important to just be open-minded and and critical of what we think we know um in order to re-evaluate it and go in new directions so yeah it's a fun process yeah well that that was the that was saying I think it was like Benjamin Disraeli said that there's three kinds of Lies there are lies there are damn lies and there are statistics right and so you can just use these you manipulate the statistics and the data to to say anything you want and it happens all the time and you know that's why I I try to go to First principles I try to look at evolutionary biology I try to look at our evolutionary paths and say okay does this line up did these studies line up with with the observed phenomena that we've that we've noticed from Millennia and that we see in the fossil record as well and if it doesn't line up I I sort of you know I think you have to ask why and you know you can have a study that says anything you can conclude anything and then even in their own methods and and results show an actual different story as well so it's it's very misleading for scientists as certainly for you know people that are that are just sort of cleaning this information from from expert opinion MH yeah for sure all right so you said you said a bit uh ago you actually you actually um signposted that you were going to do the the Oreo study on plant Chompers I didn't actually know you were on plant Chompers what what happened there how did that come about what did you guys talk about yeah we connected over I forget what it was I had some tweet or video which he commented positively on um I I I do pride myself on trying to be pretty reasonable and moderate and being able to talk across the aisle so um we really just talked to him about lean mass hyperresponders and why they're unique and and why they needed further study and to his credit he was incredibly open-minded and steel manned our position and was someone who was willing to give us a platform to speak to quote the other side who likes to make caricatures of us and say that we say things that we don't we being me and Dave Felman so he was just willing to have a conversation with us and let us you know say our piece and um I think was was was very fair and even-handed about it my impression is he gained a lot of points even going after people in their own space the one portion at the end you see him go after Thomas dpring for spreading misinformation which was was pretty amusing um Dr dpring made some Claim about that ketosis decreases LDL receptors which was not a substantiated claim it was was really interesting in retrospect to see how people including doctors responded to that information as if it were just like he was a lipid God and he had just bestowed some wisdom I was asking in the Moment Like can you share data because I'm actually aware of at least mirring data to the contrary and one human RCT to the contrary he never provided any data nevertheless it was anyway it was it was to Chris mccal plant Chompers credit he was willing to stand up and say look like you know Nick's keto I'm plant-based which aren't necessarily mutually exclusive but nevertheless like here's the phenomenon that they're studying is pretty interesting and here what the data show so far and um yeah in in that context I was I was uh willing to share that I'd be doing this experiment I also had and he's already tweeted about this so I'm at Liberty to share it um a second episode with Chris PL Chompers yesterday nice um he flew over from California to meet me in Boston to go to the home of Walter Willet and have a conversation interesting so that was a a lovely conversation and he'll be dropping it I think in two parts um but again it's it's it's interesting to see the responses on social media like oh I can't believe these people are having a you know a polite conversation people can disagree about certain topics and still engage in a fair and respectful intellectual manner about interesting scientific things so in that episode we also talk about the Oreo study and it it is a very interesting thing for me and it was something uncomfortable you know as a student at Harvard Medical School bringing up with you know Professor Willet who obviously a big name um so yeah I'm a student and I'm lowering my cholesterol with Oreos let's talk about that it's uncomfortable but like you you put yourself out there a little bit and when you when you cave it appropriately and and I think I'm pretty forward about your intentions especially as a student generally people are pretty interested and respectful as he was so um yeah people can look for that episode um Chris has been great I think you know I definitely don't see to him eye with eye to eye um on everything but uh you know when you meet people in real life or you give people a chance and you speak to them you know not in tweets you'd be surprised how much Common Ground you can find and how reasonable people tend to be so I try to make that effort when people are receptive to it to have a conversation um behind the scenes either on the phone or ideally in person someday because you can then usually circumvent the problematic incentive structure that arises on social media that leads people to be very Punchy and can lead to um let's just say tension that sometimes I lean into sometimes I try to diff diffuse you know depending on the day and how I'm feeling we can definitely go into examples of that but no I think I think it's it's actually pretty easy when people are going to have a conversation to have a pretty reasonable conversation the issue though is often people aren't like Chris aren't like plan Chompers and aren't even willing to platform you or have a discussion so it is very frustrating to me when I see Peter AA you know rolling his eyes talking about Lee Mass hyper responders I'm like dude you're not even trying to have a conversation he's like you know I did a response video I think was pretty respectful you can watch it on my channel but I'm like look here are your points that you make that are pretty decent but you're saying you're trying to understand this thing you looked for explanations I've given a few that you've not replied to I know you know who I am I have intermediary that can send messages on to him Bob Kaplan who is his head of research previously and who was actually a author on our liid energy model paper it's like look if you want to be you know genuine let's just have a conversation give me the chance to talk to you um and that goes for everybody you know I've invited people like Thomas dpring on to live conversations to like you know if you think I'm spreading BS call me out on it I'm going on Kem Barry in a you know a day or two he's inviting you on live this is live in front of you know potentially three million subscribers you think you can call me out on BS come and do it like I'm happy to have this conversation but you need to give me the opportunity to have the conversation and I find that you know squeaky wheel gets the grease if you become someone who people are looking at there's a little bit of forced platforming I think that will happen with the Oro versus Staten I don't think people will be able to avoid wanting to talk about it that's the goal that you know now you kind of have to like there is no more I can craft the narrative without you it forces the conversation that's the goal and in in a space where in absence of that otherwise I might not you know have the platform so I'm playing with all this I'm 28 I don't really know exact what I'm doing on social media I'm trying new things and this is a new thing so we'll see how it goes maybe I'll regret it horribly but I'm I'm I'm interested to see I'm interested to see how this all evolves yeah I I regret a lot of things in my 20s so you know you being you know that's not uncommon but uh I don't think I don't think this would be something you regret I mean this is this is opening the conversation you know this is uh this is at least getting people to talk about it like you say and and you you had an opportunity to speak with um you know chrisl Choppers but you know I've seen a few of his videos and I think he's a very reasonable guy I get the impression that he's he actually believes this's he's trying to do the right thing I obviously disagree with him on the at the end result but I I don't disagree with his motivations and um and how he comes about it but um it is it is interesting that he was able to to bring you on and that's very interesting you got to have a a conversation with him and Walter will definitely look forward to seeing that conversation um as well because he's obviously a massive massive name in nutritional research and specifically you know pushing a plant-based sort of uh narrative and and then showing that sort of data yeah one thing I'll add that I think helps with the conversations that I do have is I really do like to stay in my Lane with respect to um what I'm talking about in nutrition and specifically within lipids um to clarify that further I think the topic of what we eat becomes um is a topic that it's easy to like have different spheres related to what we eat bleed into each other so planetary health and animal ethics and nutrition and these are in culture and these are all things that are relevant to what we eat and all part of the conversation but I think we do need to be careful about separating them in order to have focused discussions um before we then combine them and consider the factors together otherwise you end up with like a duck duck dip and Dodge and distract conversation that's just not helpful to anybody a good example was the recent um um you are what you eat documentary it was like number one on Netflix for a while and it was supposed to be about the Stanford 20 experiment and I resisted watching it because I knew it would just be a propaganda piece but I got so many requests to review it I finally caved in and reviewed it and the most frustrating thing for me was that it was it was it was a um bait and switch it was supposed to be about the Stanford twin experiment a nutrition study on twins you know every episode opened with like you you know a a leadin where it's like Stanford twin study it's four episodes long you don't see any data from the study any data until the fourth episode the first three episodes have no data in them whatsoever and in the fourth episode it's only a tiny portion of the data the entire rest of it is a propaganda piece talking about other topics including planetary Health which should be spoken about you know but in the appropriate context like I don't want to go see to the movie theaters where they're saying you know the the movie's going to be Star Wars and they show me The Lion King like tell me what the topic is going to be about and deliver on that and also don't do things like try to sell me Beyond Burgers it was actually like there's there go through these like plant-based Alternatives and some of them just were not even consumed by the participants like here are these Stanford students making plant-based eggs and you look at the paper and the supplement it's like did the participants eat any plant-based eggs any at all no zero like why are you telling me about this and a documentary that's supposed to be able to stand for twin study about making plant-based eggs which the participants ate none of like so it's a difficult conversation to have when people are always trying to pull something else into the conversation look I get the emotional um you know argument of seeing like you know a chicken that looks very unhealthy and is falling in mud and that's sad and I don't want animals to be mistreated at the same time it's not exactly relevant to the health conversation it's a related conversation and we can talk about you know appropriate animal agriculture but don't try to somehow like persuade me that chicken is bad for my health because this chicken looks sad those are two separate things and it's really easy to let them bleed into each other and when we can step back and say look let's have a conversation about this thing right now and then we'll have a conversation about this thing and this thing and then we can talk about them in the context then I find the conversations become Les a lot easier and people become less defensive because I'm not trying to sell anybody on a particular way of eating that is best for all the factors I don't think that there is a best diet across all Realms I think we're adults these are complex and difficult discussions to have so we can talk about the pros and cons of each of them and how they relate to health is there a place for a carnivore diet and treating certain diseases I probably think yes can 8 billion people eat a fully carnivore diet I definitely think no those things can coexist and we can have the conversation separately and when we realize that I think having focused reasonable discussions you know among people with different overall perspectives is actually very easy yeah definitely it was um it's interesting that you you sort of um mentioned petera as well I just saw well a clip I didn't watch the whole whole episode because I I I didn't care to but he was on with um Derek from more plates more dates and they talked about how are these people saying you know sort of mentioning the lean I don't I don't think that one they they mentioned lean mass hyp responders specifically but B basically saying if you are metabolically healthy that you know LDL doesn't necessarily uh matter as much you know there's a paper from uh Dr Paul Mason David Diamond and Ben bickman that made that claim say look at here's the literature on this and you know if you're if you have high LDL you have low uh triglycerides um and you're a ketogenic diet that your LDL isn't actually uh of a concern and so there is data out there um and papers out there making that claim and what he said I I don't understand this I don't understand these people if anybody understands you know uh Science and Mathematics and statistics they know that LDL is causitive is 100% proof that LDL is causitive neglecting the fact that there are no studies showing causation between LDL and um cardiovascular disease and the only ones that have ever been done like random you can't you can't show causation with associative studies and the only rcts that were done that I know of that they gave polyunsaturated fats to replace saturated fats with to lower LDL cholesterol either found no connection no association between the LDL levels and the cardiovascular disease and in one they actually found that lowering LDL cholesterol with poly unsaturated fats actually caused more heart attacks strokes and death for cardiovascular disease as well so just wanted to see uh what you thought about that so my response video to petera was on that interview with Derek so people can watch that um because I respond to those those points directly I I'll say two things one um is on the point of LDL and causation I I found that the word causation causes a lot of confusion because I think that it's technically accurate when used as its part of the causal pathway it is part of the causal pathway it's necessary to cause um it doesn't though follow that it's sufficient to drive so I think in the more straightforward way to break it down is it's necessary but not sufficient and in the interview with Derek Peter says this directly it's necessary but not sufficient so what do you do with that information well one could argue and it's a legitimate argument if you have a disease model and you have a necessary Factor you target the necessary Factor because if you sweep the legs out from under that the disease goes away or you can't have the disease but if it's not sufficient then it doesn't make sense to treat it in every case and the answer is you know not necessarily the issue I have with that interview and I alluded to this before is is when Peter says that he's tried to understand the perspective of those and they basically they didn't name lean mass hyper responders but they talked about the high LDL the low triglycerides and I know Peter's aware of lean mass hyper responders if for no other reason that I've sent him emails saying do you want to be on our lmhr editorial in JCL to which he said respectfully no please refer to Ronald Krauss who is the expert and I got Ronald Krauss and he's now the senior author on that editorial side note that aside yeah um the arguments he makes are I think not correctly framed um like you know they're arguing High HDL and low triglycerides are so protective I'm not arguing they're protective I'm arguing they're part of a Triad that is unique with unique ideology and then he goes in that conversation directly in to the FH analogy he's like you know you know he said that bit about people who understand math and statistics and I can't he say something the effect of like I can't understand why people don't get and then he talks about famili hyperemia and how oh it's actually a you know he he Blends in things that I think will be very confusing to people like it's a phenotypic diagnosis for a genotypic condition and this that and the other it's actually a phenotype blah blah blah that aside what I've tried to emphasized repeatedly in you know my own conversations as is as a basis for what we're starting to talk about is just that misrepresentation the one that Peter leans directly into in that conversation he talks about FH and why you know it proves his point and what I'm saying is Peter you need to distinguish what we're talking about a metabolic response to a genetic condition where you have a broken lip metabolism yeah because it's you know polygenetic you can have multiple genes it's still a genotypic condition that's congenital you have it from birth you have a broken lipid metabolism is not necessarily responsive to carbohydrate restriction not necessarily associated with a particular triglyceride to HDL ratio I contrast that to a population of people who have normal LDL that skyrockets in response to carbohydrate restriction it's a reversible phenotype generally associated with people who are lean there's an inverse association with BMI and triglyceride to HDL ratio and no broken Li metabolism those are clearly distinct ideologies and so if you're not separating them from the get-go then you can't really have an evolved conversation about it which he and Derek don't because he never makes that separation he goes straight into the FH analogy which I think you know is is is a failed premise so you know he makes some good points in that conversation which I give him credit for in my response video but if you want to be sincere about actually trying to understand this phenotype and having this conversation then you actually need to have a conversation with us and people have asked Simon Hill who's um the proof tweeted that he wanted me and Peter to have a discussion on his channel I'm not sure if you know Peter was made aware of that and declined because that offer seemed to then later move off the table but um you know I'd be surprised if Peter wasn't aware I was talking about this and you know wasn't that I wasn't on his radar I would think that if he sincerely wanted to understand this topic he would engage with it my impression is he hates talking about nutrition actually in his book I didn't read it but Chris mccal did a review of it and was sharing from some quotes from it there was this one part where clearly he was joking but the you know joking not joking had a tone said something the effect of that he would prefer to fake a Grand Mall seizure than talk about nutrition again a joke but like to the point that he doesn't like talking about nutrition because he finds it dogmatic well I I do feel like you're expressing a little bit of your own Dogma if you're unwilling to have a conversation with the people who are actually leading This research so um that is me me you know providing an open invitation to have that conversation in a non-defensive manner again I think some of the things we're doing now are going to force that conversation I wouldn't be surprised if in 2024 me and Peter do have a conversation about L MIP responders and if it took me pulling an Oreo versus Staten stunt to make that happen then so be it so we'll we'll see if this if my strategy works yeah um I'm being a little bit of a provocator and that is that is completely the intent so yeah I think he's a smart guy I think we could have a good conversation and I just want the opportunity for that to happen because honestly I think his viewer base would get a lot from it including finding out that me and Dave felin and our colleagues are not keto Zell extremists we're just scientists asking questions yeah well that's the thing yeah I mean you you be very intelligent and and still disagree with people who are also very intelligent you know I mean you can it is I think the definition of of being open-minded to understand that two people can look at the same situation and intelligently and honestly come to different conclusions I mean that that's just human nature we're going to have a lot of different influences have a lot of different experiences and and and knowledge that are going to shift our thinking on something and so that's very normal and debates used to happen all the time usually have public debates all the time you know famously they would have um Nobel Prize when economics friedrick Hayek would debate uh Lord mayry kanes in England on different sort of deficits spending socialist sort of Economics versus free market economics and Hayek and and KES debated you know fiercely all the time but they were great friends off the stage they were actually they weren't attacking each other and being nasty they were just debating the facts and they're actually very very close friends outside of that you know and that's something that that should happen you know you should be able to disagree with people and still be friends with them and still be collegial with them uh we've lost that I think now it's just if you disagree with someone it's because you hate them or if you disagree with them you have to hate them or something silly like that or if you don't like them you have to disagree with them and none none of these things are the case and so you know Dr T is is a very intelligent man you know and that doesn't mean that you have to agree with him on everything I don't think I've agreed with any anybody on everything you know except people that have just said hey well here's the evidence here's Bo okay well that well you've clearly proved that you know if you find yourself agreeing with everybody around you you're you're most likely an Ault because that's the only time that really happens where you just you all think the exact same thing and there's no deviation and no deviation will be accepted um you know to the to the FH uh discussion um you know like like you said those are those are two very different populations you know you're talking about familial hypercholesterolemia you know like you said you know this this this is they they're going to have high LDL cholesterol they're going to have these problems regardless of of their lip metabolism they eat they sleep of Oreo cookies every day for two weeks probably not going to change their their cholesterol level so that's a different population but it's also is my understanding um from presentation I saw from Dr David Diamond that that actually you have to differentiate out the FH population as well because they have they have a propensity to have clotting disorders as well and when you separate out those who have a clotting disorders from the ones who only have the high LDL cholesterol it's only the ones with clotting disorder that uh seem to have higher rates of cardiovascular disease heart attack and stroke in the early decades and then after about 50 it sort of evens out that's my understanding um and as far as uh Dr is saying that you know this is higher LDL is is required but not necessarily the driver of this or not sufficient I've seen a number of studies or at least recommendations that you just need to keep lowering LDL cholesterol if you keep having heart attacks just keep lowering your LDL there's no there's no bottom floor on how lower low you can get your LDL if you can you know if you're still having heart attacks and that suggests to me and there's other uh data that shows that that you know 50% of Americans who have heart attacks you know I think they looked at something like 160,000 people half of them had low cholesterol low LDL cholesterol so maybe there's a threshold uh but I don't know because a lot of people have very low LDL cholesterol they say well let's lower it more let's lower it more and they're still having heart attacks so it's like okay well maybe we're barking up the wrong tree and so and and then when you couple that with a lot of the a lot of the the um historical records that are coming out recently like in the jamama article 2016 from you know the sugar Research Foundation in the 60s detailing how they were paying off professors from Harvard and elsewhere to basically cast the blame on cholesterol to you know because there were studies coming out so showing a very strong association between sugar consumption and heart disease and they're like okay Well's let's get let's get another narrative out there a lot of these things and one of those professors was named head of the USDA and you know he was the one who who authored and published uh studies from the USDA saying that cholesterol caused heart disease so when you you sort of untangle that and you sort of look at the basis of LDL being problem in the first place I I do sort of question whether you you actually have to have I ll in order to get heart disease as well or if it's just something unrelated entirely I mean based on the fact that patients with lower LDL can get heart disease I think it's pretty clear you don't need very high LDL and also there are patients with high who don't get heart disease so obviously it's not the whole picture um there does seem to be somewhat of a um myopic clinical view on on it as a marker just because it's very clear how to address it it's an easy W you could say if a patient comes to your clinic and they have high LDL you know what to do and you can just get the points down like it's not a hard thing and the other things like atherogenic dyslipidemia there aren't good drugs to treat it and because you know the markers aren't causitive it's not really clear what you know the the effects are and you need a lifestyle intervention to really change the markers in a productive way and that is not how our you know um medical system is built it's not built per se lifestyle first it should be um Peter Libby Professor Peter Libby at Harvard had a beautiful review I think it was in nature in 2021 it was something like the changing landscape of AOS sclerosis where he makes the point you know we've been lowering LDL more and more and we have more advances in pharmacotherapy to lower LDL and yet heart disease rates aren't really going down maybe that's because the profile is changing more people have aogen dyslipidemia metabolic syndrome obesity and you know statins aren't going to treat that it doesn't mean they don't have their place but it means we do need to take a broader view and say look what is the risk profile of patients now and how do we address it and the quote unfortunate you know a little bit of sarcasm there answer is that you know the answer might not be a pill yeah it might just be eating a species of apprpriate diet and living a healthy lifestyle maybe we can start there but nobody likes to do that so here we are yeah well you want quick fixes and people do want quick fixes but I think doctors want quick fixes more than anything you know with um you nutrition was used in a in I mean goodness how long I mean I me it well attributed to hypocrates but who knows as you know let food be thy medicine and Medicine thy food and also another quote attributed to hypocrates was you know before you um before you cure some of of their disease ask them first if they're willing to give up what is making them sick and um and these are these are eminently applicable now and you know for a hundred years we have data on and studies on ketogenic diets helping epilepsy in particular childhood epilepsy for instance and migraines and and diabetes and yeah there was a there was a there was a change I was speaking to Professor Thomas CED of Boston College you know he does um cancer research he's an eminent cancer biologist when he was doing his post do at Yale he was doing research into ketogenic diets and epilepsy he was he was following this along and and you know the someone in his Department maybe the head of the department there in neurology was um uh you know just told him like Hey you know don't worry about it this is sort of a deadend research you we have these drugs now they work just as well and it's hard to counsel people into changing their diet it's hard to get them to stop eating carbohydrates it's easier just to give them a pill and so I think it's it's probably more in you know from from our laziness as clinicians that's just like well this is easier to give a pill it works just as well you know it's hard to sort of have a look I this is my practice you know Neurosurgical resident but like I have I have a practice outside of that preventative medicine and functional medicine that I do on the side and like I have to have hourlong conversations with people to to talk to them and counsel them about diet and lifestyle and go through all these things with them it takes a long time and if you are rushed as everyone is in medicine you know you only have you're only supposed to have 10 15 minutes per patient you've got 30 patients to see uh it's very difficult to do that and so I think that that some of that that's come down on us that we've gotten a bit lazy and saying well let's just give a pill but I think it's I think we have to get back to our roots and address LIF style before we start adding pills and pills are great I think there's definitely a place for modern medicine and pharmacology but I think that you address the diet lifestyle first and you know put an epileptic kid on a ketogenic diet if they can't do it or it's not sufficient then you look to pharmacology it's complicated because you use the term lazy and I think probably we both agree this is not like the clinicians I see working you know 18 20 hour week lazy is the farest from it's the whole infrastructure around people and it becomes impossible to operate in the way we actually want to and do the best by patients because of the pressures that are passed down clinicians often have I think it seems to me at least from where I'm standing very little autonomy in terms of you know the amount of time they have with their patients um and even you know patient nutrition nutition I walk through the hospital sometimes I see plates they actually have on the receipts the carb counts I'll see things with over 250 g of carbs they like multiple Maple syrups pancakes juice Froot Loops The Physician didn't order that yeah they didn't decide what was on the menu the patient did like the hospital infrastructure set up the circumstance so that could occur that said it is an ecosystem where the Physicians are the face and the whole Hospital experience they're kind of seen as the you know the buck stops with us and so I do think while it's not clinician laziness or a clinician's fault there are a lot of topics about which we're passionate Advocates and there need to be more of us talking about the fact that no it's not appropriate to have pastry shops at every hospital entrance and be bribing people to get vacines with Crispy creams even though it's crispy cream that's doing the promotion we should say look this is not appropriate we're not going to allow this this is screwed up so that is within our power as a broader Community to do and I I think we just need to open our eyes a little bit and you know address the problem that's right in front of us and it's not a problem that's even that controversial if I go to my residents or attendings and be like can we just observe for the second that this patient has an hba1c of 13 and they're eating chocolate cake and we be like yeah that's probably a problem you know that is a problem but it's not what I like it's not my responsibility to deal with it right this moment I didn't make this decision the patient has to eat this is this you know I can't solve this right now with everything else I'm juggling in the world so it's something that you know in aggregate we need to address but I definitely wouldn't place blame on any individual for the fact that the patient decided to order chocolate cake and the system is permitting it do I think it's a good idea definitely not yeah I mean that's that's a good point it's it's is strange I mean same thing it's all over the world as you know I've I've um been in hospitals on four different continents now every single one is the same it's just sugary carbs sugary carbs sugary carbs that's just what that's just what patients get and you know it's h that I think that in itself is a problem but it's low fat that's that's the key you know and yeah low sodium low cholesterol low fat yeah orange ju high sugar yeah exactly high sugar high carb and uh yeah you know frosted Frosted Flakes and things like that you know and so it's um it's a bit it's a bit strange I think that's that's a fundamental problem as well I do think that know of course people aren't working 18 hours aren't lazy it's not that they they can get overwhelmed by things but I think that's that's something too I mean i' I look at these sorts of things and I have a problem with it and I don't have time on rounds or or anything like that to do it I will come back and I'll talk to those patients sometimes and just say hey you know you know maybe this is a better way of doing it and I come back on my own time it's difficult to do and when I'm counseling patients in in the clinic uh it takes a long time and but I I feel that it's it's uh it would be unethical to not talk talk to them about it um you know especially something that I think that would help them in a number of different ways which is why I like the the you know preventative medicine practice as well because you you do get to have longer conversations with people and you can sort of fles these things out as well and that's that's honestly why I started a YouTube channel is just I could say look I don't have time to talk about all this stuff here are some videos you you can watch and that that my God has helped a lot with h with time saving but yeah it's gratifying to be able scale yeah there's a there's a Doctor Gary fety really nice guy he's an orthopedic surgeon here in Australia and he um you was famously attacked by the the dietetics association in Australia um the the head of the Ada the Australian dietetics Association personally called the CEO of his Hospital tell him that you need to shut this guy up you need to shut him down because he was prescribing ketogenic diets to his his patients to try and avoid getting his diabetic patients to try to avoid leg amputations and it was working and and they were telling that you have to stop this this just like he's he's actually helping people he's objectively helping people um interestingly enough um organization here called low carb down under which is a group of doctors that put medical conferences together for uh low carb sort of research um they actually sued for the minutes of board meetings of I don't know which serial company but may presumably one of the ones here in Australia um but I don't know um and they found that in this board meeting they they said hey this whole ketogenic diet movement is really screwing up our serial sales and we need to Target certain voices in the ketogenic Community uh and we need to shut them up and they named Dr fety by name in that we need to shut this guy down and they're the major funders of the dietetics associations in America in the UK in uh Australia and so they pulled their strings at the Ada in the head the Ada calls Gary FIS hospital and says you need to you need to shut this guy up you need to shut him down and they and they went after his medical license and he had to fight that for years and uh and go through the courts and everything like that and um it was absolutely ridiculous so yeah there's some some crazy stuff going on but one of the things that uh Dr fi said was that you know once you see this once you see how powerful these nutritional dietary lifestyle changes can be in people's life you can't unsee it and can't not use it as a clinician and that's what he started using with his diabetic amp uh diabetic patients that were needing amputations and all of a sudden they didn't need the amputation so they didn't need as as extensive of an amputation and then his joint replacement patients too they come in and say hey I've got this bung shoulder this bum knee and they're like yep you you qualify for a joint replacement book you in for three months but until then you need to be on this diet and they're like okay all right whatever you have whatever I need to do to make sure this goes well and he says that more often than not he would get a call at about two months from these people to say you know what I don't think I need surgery anymore my my shoulder feels fine my knee feels fine says great no problem just let me know if you need if you need anything else if you if something changes you know so I think there's ways you can do it and when you see how powerful it is as a clinician and you see what a massive difference this makes in people's lives I mean you've seen it in your own life so you know you know so you're already there you know but if you if you see how much it it can change people's lives I don't I don't see how you can do really anything else because it makes such a big difference in people's lives and when you when you see that and the amount of comments that I get on on my videos or I get you know personal messages or just my patients that I see the the radical changes that I see in their health it's just you know and I get a lot of heat from a lot of people Simon Hill included who to say that I'm I'm doing horrible things to people and yet that's it's like a you know it's like a fly on the wall I mean it's just like it's it's nothing compared to the inundation of people that are telling me this has radically changed their lives and so you know I don't think I could I don't think I can go back to just sort of doing things in a traditional way and ignoring that I think I have to do both even in neurosurgery I'm going to be counseling my patients to eat a certain way and to benefit their life and Hope hopefully avoid surgery because even though I really enjoy doing surgery I don't want to have to do it on someone who could avoid hey everyone if you need a little extra help getting started on a carnivore diet and my online resources that I have for free aren't enough for you you can go to www.how carnivore decom and sign up for our 30-day carnivore challenge where you'll have online Resources Group support weekly Zoom meetings as well as the ability to chat live with myself Simon Le and the others in the challenge who can help you and support you and give you extra advice and help you along the way so if that sounds like something that would be beneficial to you then please go to howc carnivore docomo been keto for a long time what do you eat at the moment and um do you think that you've see that changing are you happy with with where you're at yeah when I started a keto diet just because of taste preferences and what I thought was healthy at the time it was very Mediterranean esque lots of like avocado salmon I've just toyed with a lot of forms of Keto all of them are sufficient for me to have don't have not have IBD flares I will say my stomach operates better when my fiber intake is lower so I'll eat a lot of eggs and salmon some red meat nothing against it I just love fatty fish and um I really love cheese so I will eat a lot of cheese I had a guess probably most of my calories come from olive oil salmon and eggs um I love me some good orgon meats and a good steak as well when I'm on clinicals I do tend to eat carnivore plus olive oil I'll say kind of on that Spectrum it just allows me to operate a little bit better I love larb vegetables like like a bowl of you know roasted Brussels with walnuts it will just take a little bit of a uh a toll on the the GS system in the morning literally so i e and flow i e and flow I I like the taste of it I mean like quite honestly if I didn't need low carb therapeutically like there are things that I like like you know I love make a you know sweet potato with some goat cheese and figs I've never used low carb for like weight loss so that's not an issue for me um every now and then I'll I'll Flex out have like a little like the other night I made um my my partner like a honey roasted carrot dish with a tahini garlic dressing and had some of that so I'm not super strict about it but I I do remain in ketosis with a primarily animal-based um basis and uh yeah it's worked well for me I could not eat bread for the next hundred years and be perfectly happy I don't feel like I'm missing out on anything um and uh yeah it's really surprising how you recalibrate and how much you can enjoy simple eating when you know if you had asked me when I was a teenager Nick do you imagine not eating like sugar and pie and ice cream I would have been like you're crazy like I could not go a week without eating ice scam and now I'm like I don't care I don't need it there's no Drive you're liberated of a drive that you think is intrinsic to you to have this crap food um and then you learn you can actually enjoy just as much something that's really simple I don't have a Sweet Craving often but like if I do some like red pitted Frozen cherries right out of the freezer like two or three tastes great I'm totally satisfied so yeah I I am really enjoying the lifestyle and I find the hardest part is the social aspect but I also find that if you stick with it people tend to gravitate towards what you eat if you're doing really well and they see you doing well this is especially true with weight loss um like I know I don't know if you follow everybody by the way if you're not following him need to follow Dave Dana he goes by Dave e Dana and if you've been following his story he started on Twitter a couple years ago he was over 400 PBS and he went low carb and has been losing weight just consistently he's now lost 138 pounds but like along that Journey he's mental Health's improved Financial well-being he completed his NBA he got married he's the guy that's been getting props constantly from Arnold Schwarzenegger like when he got married Arnold put like a 12C clip saying like props on how well you're doing he really blown up and is just a positive source of um a constant source of positive energy but one of these people who look it takes some activation energy to change your life it's going to be a little bit socially uncomfortable for a period of time but then there's a a flip in the switch where people aren't saying oh you're weird for not having the office cake they're like wow what you're doing is really cool I want to join and it becomes a positive social Force rather than a negative one I find yeah no I totally agree and I've noticed that as well that um when you're when you're when you're quietly confident about what you're doing and you're doing it for very clear reasons and you have justification for those decisions and people see the results the clear results in in you that they start become interested as well you know I mean my my entire department has has at least flirted with carnivore and is at least uh dramatically increase the amount of meat that they eat many have done keto couldn't quite Go full carnivore but many tried carnivore and then you know um some of them stuck with it and others for sort of logistical family reasons other people weren't really doing it with them and they're like oh well you know I guess I'll go away but they all said like they felt amazing doing it and then you know just because they just wanted to eat what everyone else was eating which is you know it's understandable um you know they sort of went back to more but eating a lot more meat and um yeah I've noticed that as well that that more and more people around the hospital started eating a lot more meat and then I would be in like the you know the emergency room like you know seeing patients and things like that like riding my not and then like one of the like the the Ed Consultants will just sit down and just start like talking to me about it and I'm like I've never talked to this guy about it in my entire life but he's starts to okay so you know when you eat what do you do and you do this like okay you know because it's just just more more people are getting interested in it and I I I agree you know that when you when you have that positive influence you other people see that and um and and it can be very self-conscious for people at first um but once you get you know accustomed to it a climatized to it it it actually is is isn't a source of embarrassment most of the time people are interested in it as well and the less you sort of talk about it the less it sort of you know goes by the way people just don't even it's just normal you know if you're not drawing attention to it there's nothing to draw attention to yeah agreed very good all right well Nick thank you so much that's been absolutely fantastic conversation I absolutely I absolutely love it I'm really glad we're able to connect it's been um it's been an absolute pleasure I'm really glad we're able to do this um also want to say you uh please let us know where we can find you where we can follow you and also when the Oreo study I mean we're probably going to publish this after the Oreo study comes out and we'll try to put a link in the description people probably hopefully share this around on their social media and try to really publicize this and get this spoken about um but where can they find you where can they uh support your work yeah so so I'm Nick norwitz n i k n o r w TZ on Twitter I'm pretty active there and then um yeah the the call to action from me would be just what you said um this video will go out presumably when the Oreo study drops which I think from this recording will be probably next week it'll be before the metabolic Health Summit in Florida at the end of the month so um what we really want people to do is take the link from the paper and put it in an original tweet or a quote retweet including that link um it helps boost scoring metrics on attention and that's really important for pushing this conversation forward and in addition to that if you'd please take the eight minutes um to watch the video abstract covering the paper my friend and colleague Dave Felman um did the animations it's absolutely beautiful I think you'll really en enjoy it so that's 8 minutes and I'm hoping for that to go viral um the even the leak video did did pretty well so we'll see how well the the video abstract does but I'm hoping for six figures maybe seven views on that so if you know you could be one of those and share that around that will be wonderful as well it'll all help push the conversation forward and um yeah I mean for those listening up until this point in the conversation thank you very much and I really hope you do you know get provoked by this this little stunt on polling and want to engage further with the other robust research we have going on yeah and I think that uh ties into the lean mass hesp data that came out as well which showed that you know after what was it like a year or more on just a high fat keto diet with very high LDL cholesterol did not show any progression in atherosclerosis is that correct that was yeah 4.7 years so there's a study going on out of the L Institute and the Baseline data came out from that in which they matched a population of 80 um people on the lean mass Hypes Spectrum with a mean LDL of 272 to a similarly healthy population the Miami heartt cohort with an LDL average of um 123 if you want to do out the math there if average time on keto was 4.7 years um multiplied by the delta in the LDL which I think was 149 you end up with something like a 700 milligram per deciliter year difference which is pretty high in terms of exposure to LDL and what was found was that the key group did not have increased plaque in fact if you looking at the Trends they were trending to lower plaque and there was no association between LDL and total plaque score now these are preliminary data nevertheless they're an evolving part of the story with the respects to lean mass hyperresponders and by the time this video comes out we should also have a meta analysis of randomized control trials published in the American journal of clinical nutrition so you'll see me tweeting about that um there is a robust body of literature evolving and this whole little Statin versus Oreo PR stunt is to get you to turn your heads and look at that body of literature so hopefully you will be provoked and engage with the broader body in the evolving story absolutely well I'll try to put all the links for those uh for those uh pieces of lature in the in the description so people can take a look at that and I encourage them too and hopefully they can read them and share them around and and get more attention to them uh Nick thank you so much for coming on it's been an absolute pleasure thank you so much