Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz

The Oreo cookies lowered my LDL by 71% in just 16 days. I think the top 10 drugs only help like 1 to 4 to 1 in 10 people who take them.

Nick Norwitz is a Harvard med student. An Oxford PhD who reversed his own chronic illness.

And now he's redefining what science says about food and health.

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Because this oil is minimally processed, it also contains pro-resolving mediators or PRMs, which further boost the value for immunity and cellular health. I personally incorporate Omega-3 Rejuvenate into my daily supplement routine and it's a staple for patients at my Ultra Wellness Center as a convenient and effective way to keep up with your body's daily Omega-3 needs. To try Omega-3 Rejuvenate, visit BigBoldHealth.com and use code DRMARK25 at checkout for a special discount. Prioritize your health today with this amazing supplement. Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hyman Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website at drhyman.com for my website store. for a summary of my favorite and thoroughly tested products. Now, before we dive in, I wanna make a quick note about this episode. This conversation with Nick Norris was released before the release of a new keto diet study co-authored by today's guest, Dr. Nick Norris. Now, this study sparked a lot of interest and a lot of debate online. It was pretty interesting to see the amount of blowback it got. And now, while this new study isn't discussed in the episode, the study that I'm talking about now, the conversation gets into some of these topics and offers valuable context on what led Nick to explore this topic in the first place, including his own health struggles and a now viral experiment where he lowered his LDL cholesterol by eating a whole sleeve of Oreos a day. It was very fascinating. He's a character. Welcome to the Dr. Hyman Show. This is Dr. Hyman, and this is a place for conversations that matter. And today, if you're confused about nutrition, I can't promise you won't be confused to the end, but at least you'll be more educated because we're talking to a MD, almost MD from Harvard and an Oxford PhD who's made it his job to understand the science beneath nutrition and metabolic health. His name is Nick Norwitz. He's a graduate, valedictorian from Dartmouth. He majored in cell biology and biochemistry. He went to Oxford to get his PhD in metabolism and studied ketones and Parkinson's. He is enthusiastic person, to say the least, he's very passionate about understanding the underlying mechanism behind our chronic disease epidemic and our metabolic health. He's personally suffered from severe inflammatory bowel disease and cured himself of it through food, which I think is important to take note of. He's making a name for himself online and he is also making a name for himself through the academic work on various diets and approaches through Scientific literature including ketogenic diets, cholesterol, lipids, LDL, and he's a great scientific communicator with all kinds of expertise across a range of things that I don't even think I understand. His mantra is stay curious. He loves hard questions and we went through a lot of hard questions today. We talked about all kinds of things from whether artificial sweeteners are good or bad for you to what does LDL do in terms of your body's risk for heart disease. And it is at the boogeyman we thought it was. We talked about carnivore diets, vegan diets, and lots more. So, stay tuned for an amazing conversation with Nick. Well, Nick, welcome to the Dr. Hyman Show. It's great to have you and I have been following your work, which is such a joy because you have a brilliant way of breaking down really difficult scientific concepts into digestible bites that people can eat. It's sort of like a digestible diet of science. and you're, you graduate from Oxford with a PhD in, in studying effective ketones on Parkinson's disease and ends up at Harvard Medical School, where you become sort of a little bit of a fire brand kind of, and, and having a side gig as a sort of YouTube educator on metabolic health, which is, I think, pretty amazing given all the things you've got to deal with when you're in medicals. Maybe you can kind of take us down how You first sort of got interested in this and then what happened with your own personal health journey and how you sort of experimented on yourself as a human guinea pig to figure out a lot of things that work and don't work when it comes to health.

First of all, thanks for having me. I'm very excited to be here and have this conversation. As for my backstory, I grew up in a household of both my parents were MD PhDs and I always wanted to do medicine and science. I was always fascinated by biological sciences. I always had highest esteem for the medical profession, so that's always what I wanted to do as long as I can remember. That said, I had a very fluffy idea of what nutrition science really was. I think my understanding- Fluffy idea? Fluffy, diminutive- It was kind of not real medicine. Yeah, it was one of those things where I think a lot of people still think, oh, I kind of know what healthy is. My plate before that, the food pyramid, eat a balanced diet, eat your five a day. I would say a lot of platitudes, but platitudes that people take as gospel. I Generally felt that way as well. I kind of knew, or I thought I knew, what healthy was. You know, I eat my fruits and vegetables, not too much saturated fat, not too much salt, and then get enough energy to fuel my activities. And blessed or cursed, I don't know what you want to call it, I was a young person who never struggled with my weight. I was a pretty athletic young person. So throughout high school and most of college, I really didn't think much about my diet. And then things took a little bit of a left turn for me at the end of college when I started to develop inflammatory bowel disease. Before that, I was Colitis, ulcerative colitis. So, what that looks like for people who don't know, sorry if this is a bit graphic, but bloody diarrhea 12 to 20 times a day.

No fun.

No fun whatsoever. And it was a really big shift for me because before that I had no dietary restrictions. I was known as the trash compactor of the family and my friend group. And I loved adventurous eating. It was one of my favorite parts of traveling. You can catch me eating basically anything. But I went from that to being able to eat basically nothing that didn't upset my stomach. Just to kind of give insight into the psychology of, or the psychological impact of something like ulcerative colitis, you become, well, I'll say, the physical impact is only a tiny fraction, the tip of the iceberg, of the whole impact because it really causes you to withdraw from life socially, psychologically. At this point, I'm finishing up college, starting grad school, and as a young man, I'd imagine I would, you know, be going out with my friends, dating, just to kind of give like a quick example. Dating's not really on the table when, you know, if you're gonna have a girl over, you might have bloody diarrhea in an instance. Not really a romantic, not fun, mood setter. So you just let those things drift away. And for me, it continued to get worse and worse. After graduation, I went to Oxford to do my PhD, and that's when the shit hit the fan. Pardon the pun. Almost probably literally did. I started having these terrible flares and.

Ending up in and out of the hospital.

Yeah. ICU down to like 90 pounds. I'll care. At some point, I was under 100 pounds. I was so malnourished, my heart rate was hitting, you know, getting to the twenties. I had gone in the period of a couple years from apologies for patting myself on the back, but this was the reality. I was a top performing academic, valedictorian in my college, sub three marathoner, breaking state push-up records to being so frail that getting up and going to the bathroom cost more energy than running sub three marathons. used to. And on top of that, you know, my sub three hour marathon.

So that's a pretty good feat. Yeah.

I mean, I'm a pretty intense person.

Really? I haven't figured that out yet.

Well, if you Google, this is one of the funny things I did. Yeah. When I get my mind on something, I never stop. 2014 Boston Marathon. This was the year after the terrorist bombings, and I'd always wanted to do the Boston Marathon. So I qualified doing a sub three when I was 17, which actually made me the youngest time qualifier for the 2014 marathon. But if you look at my time for the 2014 marathon, it was just under seven hours. And that's because I ended up breaking my tibia right before the race. So I did the whole marathon on crutches. Wow. Which I had to get special permission to do. Anyway, back to Oxford. Yeah, no, my quality of life had been completely destroyed. I was barely staying afloat with my studies, doing a lot of my work from the hospital. No social life, no romantic social life, really just had nothing beyond what was on paper for me.

And you basically were studying a keto diet in a sense, or the religious- Exogenous ketone. Yeah, taking them not by diet, but actually by supplementing with ketones, right?

Well, that's the great irony is you'd think I'm in a ketone lab and then I start a ketogenic diet. Somebody might intuit like, oh, he was informed by his studies. That's not at all what happened. So I had read a beautiful paper by Cox et al in Cell in 2017 about exercise metabolism as an undergrad from this lab in Oxford using exogenous ketones, this ketone ester that had been developed using a grant from DARPA. US military, some super soldier project to enhance athletic performance and cognitive performance. So I was just drawn to actually the possible physical performance boosting effects and just metabolism and physiology. So I went to this lab because I found the work just really fascinating. Using the tool as a supplement, completely separate from the diet. At that time, starting at Oxford using ketone esters, I still had a very negative view of the diet. My PI actually did as well. Her name was Kieran Clark. Keto diet was still in my shit list, I guess you could say, or I had a very negative perception of it. Like I think a lot of people do based on what you see in the media around ketogenic diets and what I had internalized through growing up as a kid in the late 90s and early 2000s really about what healthy is. And I just could not conceive of a world where a high fat, very low carbohydrate diet was a healthy diet.

We were all trained that fat was bad and then fat made you fat.

And fat causes heart disease and it's terrible. Yeah, yeah. So I had a very negative perception of it. Now, how I ultimately found my way to it is after a couple years of trying standard therapy for ulcerative colitis, I just, I wasn't getting better.

And it was even then, like steroids and. Yeah. And immune suppressants and.

Yeah, all the regular stuff. All the regular stuff, you know, first line therapies and then steroids for flares. And, you know, like, I'd, I'd exit a flare and go into remission, and then I just relapse, which is obviously incredible, incredibly frustrating. It was just. tearing at me from the inside. I just, I couldn't be a reliable person. I couldn't say yes to offers that I wanted to say yes to because I just didn't know what would happen to me. I got very desperate and I started experimenting with things. I didn't think diet would help, but I had nothing to lose. So I started experimenting with diet because.

You know, on a super, I was guided by something because there's a really key paper I read years ago about.

Autoimmune paleo diet for ulcerative colitis and Crohn's disease. It was very effective. I tried paleo, I tried Mediterranean, I tried vegan, I tried, you know, pescatarian, anything you can imagine I've probably tried along with the standard things like low FODMAP, specific carbohydrate. And I try them pretty rigorously for like a month or so. And then eventually I came to a ketogenic diet and I just thought I'd try it because what the heck? And what happened for me was my inflammatory markers dropped to the lowest they'd been since my disease started. I started feeling so much better, getting my energy back, getting my mind back. And then the next time I got a colonoscopy, I was in biosupervised remission. which was stunning. And I was forced to reconcile with the fact that this was my lived experience. This has been my lived experience despite the fact that it's not a, quote, evidence-based approach. So a lot of what I've been thinking about with respect to metabolic health.

The absence of evidence is not the evidence of absence.

You beat me to the punchline. But, you know, I had heard that saying before starting medical school, but it really didn't sink in until I started to think about, you know, our current biomedical infrastructure, business models around health and why certain interventions would or would not be explored. And basically the realization I came to-.

It's not an appeal and you can't patent it and you can't sell it for enormous profit. And so, no, diet is not something we study.

Right, so it hasn't been properly explored and which makes it to me the low hanging fruit We're treating all these chronic metabolic diseases, which we have been poorly equipped to address. Cardiovascular disease, inflammatory bowel disease, obesity, diabetes.

I'm starting to sound like a health issue. Mental health issues as well.

So- Dr. Whole departments of metabolic psychiatry now, we've had- I know. Dr. The head of that from Stanford on the podcast. Is it Shibani Sethi?

Yeah.

Yeah, she's great. I've done a little bit of work with her, Chris Palmer, Suzuki Group, Metabolic Mind. The universe of things that we could treat with rigorous metabolic therapies is truly impressive. But in order to make that standard of care, we need to grapple with the fact that they're not by conventional metrics currently, quote, evidence based because there isn't the research and funding infrastructure to do these trials with the same degree of quote, rigor as pharmaceuticals. Because again, the business model isn't as clear. It's very clear if you produce a pill and it treats a disease, you can sell that drug. and make a massive profit, even if the drug doesn't help most people. You can get a statistically significant result in a trial that you publish in the New England Journal, and it can still help only a minority of people.

Well, most drugs don't work for most of the people who take them.

They just work for a small section. I think 1 to 4, I think the top 10 drugs only help like.

1 to 4 to 1 in 10 people who take them. I mean, like statin, you have to treat, you know, 89 people for five years to prevent one heart attack. One day, it's like not very good.

Yeah.

Nick, your story is very compelling and I think you came to a sort of a personal choice about your own diet and health, but it led you down this sort of rabbit hole of metabolic health. Right. So people listening, I don't know if they actually understand, what does it mean when you say metabolic health? I mean, metabolism, I have a slow metabolism. You know, what does that mean? I don't burn calories fast, but people don't really understand what metabolic health means.

So you define it. I think the first thing to acknowledge is there's not a good definition of metabolic health. When we're talking about scientific communication, there are some terms that have very strict definitions and criteria and other terms that are more like porn where you know it when you see it. Another example, we ultra process foods. Yeah. Really defining that scientifically is difficult, but it's a useful term and heuristic in the public sphere. So I'll just say upfront, I feel like metabolic health is similar where it encompasses a lot of things and there's a lot of definitions, but I just want to be upfront. There is no consensus on what the definition is. with that said, there are different ways to slice it. The way I like to think about it is, it's when your body's, your body systems are running in a way to optimize performance and minimize risk of chronic disease. You can start to intuit that through certain biomarkers. So there's like canaries in the coal mine for poor metabolic health. Like if you have high, you know, fasting insulin or insulin resistance score, things like triglyceride to HDL ratio. or features of metabolic syndrome. You look at your waist circumference, your visceral fat.

There's a lot of things you can look at. Essentially you're talking about the spectrum of like imbalanced blood sugar and insulin to pre-diabetes, type 2 diabetes. And you don't have to have actually the type 2 diabetes to experience many of the consequences of poor metabolic health, including heart attacks, strokes, cancer, Alzheimer's, mental health issues such as bipolar disease, schizophrenia, depression. The list goes on and on, ADHD, autism.

Right.

And it's sort of fascinating how these seemingly unrelated diseases, I mean, what does autism have to do with diabetes? Yeah. Or what does Alzheimer's have to do with cancer? But yet they're connected by this common.

Thread of poor metabolic health and metabolic dysfunction. I think a way to think about it is, I don't know if I came up with this analogy, I can't imagine I did, but that of the tree of metabolic illness where, you know, if you look at a tree and you look at all the different branches, you can see each different branch of disease, obesity, diabetes, cardiovascular disease. the way we go about modern medicine now is trying to prune the tree as the branches grow. But the fact of the matter is they're just going to keep growing back. And I think the mind shift we need is to look at the, you know, roots in the soil, which are these underlying pathologies, things you mentioned, like insulin resistance and inflammation. Yeah. That are at the root of all chronic metabolic disease. And when we make that mind shift, we can, you know, gain insight into, I think, how we can more potently address disease and also why certain fundamental interventions might hit a lot of different diseases like, yeah, depression and schizophrenia in addition to obesity. And it's not because it's snake oil, it's because they all have the same underlying dysfunctions that just manifest differently in.

Different people with different susceptibilities. I mean, I think, I think, you know, at a high level, metabolism is the sum total of all the biochemical reactions that happen in your body.

Yeah.

Which is 37 billion trillion chemical reactions every second from a Top Line medical definition is when we think of what is metabolism.

Right.

But what you and I are talking about really is metabolic health as it come as determined by mostly our diet.

Yeah.

And it is driven by the amount of sugar and starch in our diet that's driving our metabolisms to be broken in some way and to not function as they were designed and to do all the opposite things we wanted to do. You're sort of came to a ketogenic diet for your own autoimmune disease, which makes sense, but it's kind of an unusual application.

Right.

And I think It's worked for you, which is great. And I'm glad you're well, and I'm glad you're doing what you're doing. But I think the deeper question is really, as a society, we're now facing a staggering number of people with broken metabolisms or severely to moderately to mildly, but somewhere in the spectrum that's driving them to poor health. And it's costing our society trillions of dollars. It's creating tremendous amounts of loss of productivity. It's threatening our national security. threatening our global competitiveness, making us all feel like shit. The question is, what is the biology underneath it? Let's just sort of unpack it and then let's talk about, you know, the different kind of approaches to it. Because I think there's a lot of views on this. You should be vegan, you should be carnivore, you should be low fat, you should be high fat, you should be keto, you should be paleo, you should be Mediterranean, you should be... I mean, it makes people crazy. I mean, I think that's why people just throw up their hands. I'm just gonna eat pizza because I don't really know what to do, you know? We now actually have an interesting test, which I, I had the first patient I've had who was able to do this test through Quest called the insulin resistance score where they measure C-peptide and insulin through a special technology called mass spectrometry that is a very predictive marker of insulin resistance. As good as you get in a sort of a, the science lab where you do very fancy invasive tests to, to measure your, your insulin resistance and it, it and it's something that I think every American should have measured. It's something, it's something that we actually now offer through function health, which is a company I co-founded that allows people access through own biology and their own data and their own labs, and it's now available. And I, I think it probably should be like the most important biological test. And yet most doctors never measure insulin. They never test it. They never look at it. They don't know how to interpret it. The reference ranges are completely screwed up on the quest laboratory because they say It's normal up to 18, it should probably be less than five. And so we, we have this moment where, where we're in this metabolic crisis. We have this broken metabolism. We have it driven by our diet that's high in starch and sugar and processed food, which is really the vehicle for it. And it's creating all these downstream problems. And as you refer to it as sort of like this, this sort of the trunk and the roots rather than the branches. And this is exactly the metaphor we.

Use in functional medicine. I don't know if you're aware of that. Do you?

Are you aware of that? That metaphor? That exact metaphor. We, we actually, I figured I hadn't, I might have like heard, I don't know where I heard it, but I'm.

Like, I couldn't have created this. It's just so obvious.

Yeah, we literally have this as a fundamental teaching tool where we show, you know, by getting to the root causes, you don't have to treat all the different diseases. You can just treat the root cause.

And then all the diseases go away. A few things I want to respond to there. One with respect to why doctors don't order these sort of tests. I mean, first rule of medicine is don't order a test if you're not going to do anything with it or you don't know what to do with it. So I think a lot of people don't know, you know, if somebody comes back with a high insulin resistance score, there's not a pill for that. So how are you going to manage it in the current, you know, , medical system. Whereas, you know, if you measure an LDL cholesterol, we very clearly have a pill that can target that biomarker and you can get an easy win on paper. I'm not saying that, you know, statins don't have their place, but in terms of like why someone would test for one thing and not another, it is the treating clinician, what are they equipped to handle in terms of data? How do they know how to manage.

The results and what tools do they have to prescribe? It's the joke I always tell. I was going to stop for saying this joke I always tell about, you know, I'm giving a lecture about why doctors don't look for where the problem is. They look for where the, where they can find something, right? So there's this guy who's looking for his keys on the street, and his, his friend comes and sees him. He's looking under this lamp post. He says, what are you doing? I'm looking for my keys. He said, where'd you drop them? He said, why dropped them over there? He said, why are you looking over here? He said, well, the light's better here. And that's what we do. You can measure LDL, you can give a Statin. But boom, you've done something useful. But insulin well, one, nobody thought to measure it. Two, and we've asked Quest, less than 1% of all the diagnostic tests that are sent to Quest have insulin as a metric that they're looking at. And number two, no one knows what to do with it once you find it high. Well, eat better, eat less, have less sugar. What are you gonna tell somebody?

Right.

Because doctors have no training in nutrition.

So the second thing I wanted to say, you just alluded to it when you're like, eat better, eat less, is, you know, circling back to what I used to see nutrition as, which I thought was a fluffy science. And I think a lot of conventional medicine still sees it as a fluffy science. Take that as, you know, the internalized perspective of what nutrition is. And now I am juxtaposing that, contrasting that to what I'm studying. We were talking about a few things offline, but things that I read that come out like every day, every week in, in the metabolic health literature that are just jaw dropping. Like a couple examples I was, was mentioning was how the body produces cyanide to boost metabolism. Like, that's weird. I didn't expect that. Or how there are cells in the brain, support cells called astrocytes that can literally, like, reach out cytoplasmic arms and connect with neurons and suck out damaged.

Proteins and then donate healthy mitochondria. Or in English, that means if you have Alzheimer's, it could suck out the.

Immune cells can help suck out bad proteins and put in healthy new.

Yeah.

So, like, the pathological Hallmark hallmarks of the, you know, leading neurologic neurodegenerative diseases, Alzheimer's Parkinson's, they come down to misfolded proteins. Imagine if you had a cell in the brain that could stick its arm into a neuron, pull these out. Oh, and by the way, these damaged proteins harmed mitochondria, the Powerhouse of the cell. So let's replace those. You stick another arm in and you give the healthy mitochondria. Like, that's something that literally happens in the human brain. A lot of this is in the area of preclinical. You can imagine this is a very hard thing to study in a living human, but just understanding the fundamentals of the physiology, the biology, the metabolism gives us insight into one, just how remarkable our bodies are, and two gives us insight into how we can tweak these systems in profound way to get astonishing results. Yeah. Like lowering your cholesterol with Oreo cookies or like, you know, sucking damaged proteins out of brain cells. They can give a lot of examples.

I'm gonna come back to Oreo cookie study.

I know. Teasing the audience, but, so the reason I want to frame these two things and I want to add in another element is what you said about people just throwing their hands up in the air and being like, too complicated, I'm done. I'll just do whatever.

Yeah, this great scientist says I should be vegan. This other great scientist says I should be eating more keto. This other great scientist said I should be eating more Mediterranean or paleo. Like what the hell?

So what I would say is, they can't figure it out. How, what am I supposed to do? What I, what I hate is the platitudes around nutrition. Things like, Eat a balanced diet, eat the rainbow. I think they're just like so useless because they're just platitudes. They have no deeper level of thought. And then on the other hand, you have this really cool physiology. But, you know, if I say to a person, isn't it cool that glycine can increase, you know, cyanide production and lysosomes, it's going to go completely over their head. So how do you, as a communicator, take your love and awe for metabolism and health and transform it into nuanced, functional takeaways for people. So you can bring them along the journey of genuine learning and exciting them about this physiology. Well, not just giving them platitudes, but give them takeaways that are actionable, which hopefully does not include chugging cyanide or misleading information around that. You can see how it becomes an ecosystem of confusion, I guess you could say. And how do you give people the respect of feeding them a nuanced message? while also not confusing them is, I think, a really interesting challenge that I've had at the front of my mind for the last year.

But also personalization, right? So I think one of the fundamental principles of, I think, medicine now is personalized medicine. And it's been core to functional medicine for a long time. You know, not everybody responds the same way to the same diet. Right. Different people need to eat different ways to thrive. And this is something that's just so ignored when it comes to literature. It's like, well, then you're turning vegan diets are healthy, or you should eat you know, Mediterranean diet or whatever that means. Is that pizza and spaghetti or is it like, you know, fish and, you know, vegetables? And I think, you know, one of the things I want to double click on is something you've kind of spent a bunch of time looking at that I've actually found in my own practice, which is this phenomena of, of, of how different people have a heterogeneous response to, their diets when it comes to keto diets, when it comes to saturated fat, when it comes to carbohydrates. and, and that, you know, simvastatin really thrive even in the face of very high cholesterol levels. And we've been taught, you know, and not just taught, but basically under the penalty of death, been, been told that if you don't treat someone with a high LDL, you're being a bad doctor. And if you don't give someone a statin with a high LDL, regardless of what everything else is going on in their biology, you are practicing bad medicine. slash malpractice.

Right.

And that, that just isn't true. I mean, like I, I had a, I just had a cuckoo stories and then we'll sort of dive into this sort of this concept of that, that I think you guys have been working a lot at Harvard and that you and my, my buddy David Ludwig, who's one of your mentors has studied a lot about is sort of the role of, of low glycemic diets in the, in the role of treating metabolic dysfunction. And, you know, I had a patient who was really struggling their weight, very inflamed, and parable cholesterol, like 300 total cholesterol, 200 plus LDL triglycerides, like 350, 400 HDL, like 30 something. It was a walking disaster. Insulin levels through the chart. And then we need, I even need a glucose tolerance test in her post prandial after eating insulin was super high as well as her glucose. So she was on the pre-diabetic range. Another guy was a 55 year old like biker who like just crushed it every day, 50 miles in his bike, lean, fit, healthy. Both of them had heard about a keto diet. And I, I said to this woman, I said, you know, I think this might be really helpful for you. Why don't we try it? And she did. And her cholesterol dropped 100 points, her triglycerides dropped 200 points, her LDL dropped like 150 points, her HDL went up 30 points. It was, you know, it was remarkable without any drugs. Whereas the other guy, his lipid particles went like Sky High, his LDL went Sky High. And I was like, well, what should we do? Like, what do you do? And, and, and I think there's a movie that you were involved with called the Cholesterol Code. It's a guy named Dave Feldman who's done a lot of work. He was an engineer, basically decided he was going to take this on as a project, you know, basically to show the world what happens when you have a whole group of people who are lean, fit and healthy, who go on a keto diet, but their LDLs go through the roof, whether it's 100, 200, 300, 400, 500, 600, 700. and it, it freaks doctors out in this movie and in some of the literature. It's like you actually get better lipids and verta health. And we've had Sammy on the podcast who started verta health. You know, you see these type two diabetics when you look at all the cardiovascular biomarkers, when they go on keto and they're eating high diets, fat and even saturated fat, their numbers all improve.

And, and yet others don't. So how do you kind of make sense of all that? To frame up why this is so important, I would first say that We've already mentioned that carbohydrate restricted diets can help with a broad range of conditions with ketogenic diets potentially helping with like severe mental illnesses, depression, schizophrenia, bipolar stuff that's really untreatable and intractable most of the time. But however, there's a, 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 context. And we need this information in order to, you know, 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, your BMI and LDL change, meaning the leaner you are, the higher LDL goes. Now, if you're very overweight and you're.

Obese and you're diabetic and you go on an extremely high fat diet, your LDL goes down. It tends to. So whereas, whereas if you're fit, thin, healthy and neck and an athlete. Yeah. And you want a keto diet for various reasons, like mental health or gut health or whatever one of the issues.

Your LDL goes through the roof.

Right.

Like yours. Yours is like 500 or something, right?

Mine's like 500, 550. So, and, and we can get into.

The saturated fat or something later, but which would make, which would make most.

Most cardiologists have a heart attack.

Right. Ironically, this is, this is true. We can talk about my profile later, the contributions there, their, contributions to that. But with respect to the literature, like we did a meta analysis of the 41 human randomized control trials with low carb diets where we had the information to like 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 looked 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 control trial literature. And I'll give a big hat tip to my friend Adrian Sotomayor, who is the guns behind that one, the first author, and then David Ludwig, who we.

Worked with on that paper. What happens when people who are obese and diabetic become thin and fit and 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 had low LDL baseline, like in the 80s. Despite that, that, that, you know, I mean, they had hydrolyzed, low HDL and probably a pattern BLDL 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 2 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 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 ApoB 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.

But what do you mean by context? 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's story. Yeah. Which is why, again, I teased Dipple, like I legitimately can lower my LDL with Oreos more than I can with the statin. That is not generalizable, but it comes down to the context because when you understand the physiology, you can get amazing results.

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Yeah.

And you noticed something radical happened and you also tried a drug to do the same thing and the Oreo cookies worked better than the drug. Explain that. So first, why I did this, people are gonna 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 was, 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, you know, 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.

But you can afford a pack of Oreos.

But I can afford a pack of Oreos per day. And so I'm like, I want to engineer something that you know, 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. That's my hypothesis. I announced it on, you can even look, Chris McCaskell, who goes by Plant Chompers, is a prominent vegan. I announced it on his platform. I said, what I'm gonna do is an experiment. In this experiment, I'm gonna lock in my diet as a kind of strict baseline ketogenic diet, my normal one, for a couple weeks. And then I'm gonna do an intervention where I eat Oreo cookies, a sleeve per day. So that's 12 cookies, about a hundred grams of net carbs in addition to my diet. So I'm not swapping out fat, I'm adding this. I'm actually adding saturated fat along with sugar and carbs for about two weeks, and then I'm gonna do a washout period. kind of reset everything and ended up being a three-month washout period. And then I'm going to try high intensity statin therapy. So it was Crestor 20 milligrams for six weeks.

That's very high dose. No one does is five and, you know, is good. And 20 is a lot.

I wanted to steal man the comparator, which in this case was, you know, Frontline therapy statin therapy. In addition to this, I. I know how to dot my eyes and cross my T, so I went to Harvard. Their institutional review board got the appropriate exemptions for this experiment. Had my PCP ordering all my labs into my electronical medical record. And then I got a consultant lipidologist. I don't know if you know Professor William Cromwell, but he trained Thomas Dayspring, Thomas Dayspring trained Peter Attia in lipidology. So William Cromwell, over 30 years of experience, he's the senior author on this paper and was consulting. So I did this as by the books as you could an Oreo experiment. And then I executed and published the results, which were that the Oreo cookies lowered my LDL by 71%. 1% in just 16 days. Now, the reason it was 16 days and not 14, I had mentioned two weeks, was because at the two-week mark, the drop was so astronomical, we wanted to make sure it wasn't a lab error, so we wanted to triplicate. So we're saying we're gonna measure the next two days. And it was still dropping. So that was the effect of the.

Oreo, and then the statins lowered my LDL by 32.5%. So- so more than double the effect.

Of the- In one third of the time.

-By eating Oreo.

Explain that, because that doesn't make any sense to most people listening. It comes down to- Explain it yourself, doctor. Me understanding the physiology in myself. talked about different things can drive biomarkers up or down and the context matters. So our understanding of why lean people have high LDL and low carb has to do with the fact that the leaner and the more insulin sensitive you are, when you go low carb, when you go keto and the carbohydrate stores in your liver starts to drop, it kicks off this cycle whereby you're burning a lot more fat as fuel and you're actually releasing more free fatty acid from your fat cells into your bloodstream. And then those free fatty acids need to cycle throughout the, the, the liver and then back through the body. So they get taken up by the liver, packaged on these big ship like particles containing cholesterol and stored fat. They're called VLDL. And then the VLDL dropped the stored fat, the triglycerides back off at the muscle tissue and the fat tissue. And what happens in this process is, is those, that those big particles that are packed with the stored fat have the fat siphoned out of them, they shrink down into LDL particles that contain LDL cholesterol. And what you end up with as a result of this system is very high LDL. Because you need it to transport the.

Energy around your body so you can use fat as fuel. It's like a decay product of the.

Thing that was transporting the energy effectively. An epic phenomenon. So yes, there are these particles that are the precursors to LDL. They drop off their cargo, the fat, at fat tissue to replenish small fat cells and muscle tissue. And then the VLDL will shrink. VLDL is like a more like less triglyceride rich particle. The VLDL has a lot of triglycerides in it. It drops off the triglycerides and becomes an LDL, which sticks around longer than the VLDL. So what you end up with is actually very low triglycerides because the triglycerides get sucked out so fast. Triglycerides are low, not high. Your LDL ends up being very high because the VLDL are being turned over really, really quickly into LDL. And then as an added nuance, when the VLDL shrink, remember they're big spheres, they lose surface components. from their shell, you could say, and some of that is cholesterol that gets picked up by HDL. So the result is this pattern of very high LDL, high HDL and low triglycerides. The high LDL, the high HDL, the low triglycerides with particular thresholds is what we call lean mass hyper responders. And is this pattern we see on lean people who go low carb. We can get a little bit more into the model if you want, but the point is the model starts with your metabolism shifting towards lots of fat burning. So if you put carbs back into the system, it puts the brake on the system, or at least takes the foot off the gas pedal and your LDL should drop. That is the prediction of the model. So it should drop with any carb. The fact of the matter is even before I did the Oreo, I had used sweet potatoes in patients. There are case reports on this or fruit or starches. It just wasn't sexy enough to catch headlines. So I'm like, What is? And I'm like, Oreo cookies, that should do it. So I did it in a rigorous controlled experiment with, you know, my locked in baseline diet, a pure addition. You can look at all the macro breakdowns in the paper. And the result was the Oreo cookies lowered my LDL by a dramatic 71%. And I'll just say as an aside.

This is what we call an N of one study. And I think this is a fairly rigorous type of data that's been mostly dismissed, which it basically means you're studying yourself against yourself.

Right.

And different diets and different conditions with a break in between. That's called the washout period. And that is not something that we typically think of as valid data. We only think of these large randomized controlled trials as being valid, but those are great for looking at pharmaceuticals, but not necessarily looking at other stuff.

Well, the fact of the matter is, I think you learn so much in science and metabasin by studying the outliers. And when you do the randomized controlled trial, yes, it has certain benefits, but your by the nature of the study, looking at a large group of diverse humans. So when you get a, quote, statistically significant result, that doesn't speak to any individual in the trial. And if we want to shift medicine towards more focusing on targeting underlying metabolic dysfunctions in an individual manner, then we need to start taking the mindset of n equals one medicine. And we have more and more tools where we can do this. Things like multiomics, where we take an individual's like genome and microbiome and transcriptome, you integrate them into an incredibly high resolution picture of the individual. If you take that mindset, then you can get incredible results in a reproducible manner, like lowering your LDL with Oreo cookies. I'm not saying that's healthy. I'm just saying it's incredible. And it's explainable when you understand the physiology. And is it generalizable? I've actually had other doctors at Harvard replicate this who are lean mass hyper responders. They're actually quite a a decent number of lean mass hyper responders and people.

At Kino at Harvard. And I get texts like- you- got.

A lot of subterranean keto community at Harvard. Atheists in the clergy.

Yeah. You'd be surprised.

Keto, carnivore- who are in the medical community.

Yeah. I mean, they- not just sort of.

Like studying history, but- no, I know senior attendings who are like carnivore lean mass hyper responders. And they're not out about it because it's stigmatized. They don't want to have to deal with the headache that comes with putting that target on your back. so most of the time, like, a paper will come out and they're like, Nick, did you see this BS about red meat? Will you, like, respond to it? I'm like, you want to get up there with me? And they're like, Nah, nah, you do it. It's true. It's, it's a very stigmatized dietary pattern, keto and to a greater extent, carnivore. People generally, be they, you know, your, your person in the general public or, you know, a senior MD PhD are.

Gonna do what makes them feel good. Yeah. And so if that helps them function and feel good for whatever reason, they're probably gonna do it. They might not be out about it, but so let me sort of back up because you, you covered a lot. I want to make sure everybody listening. Yeah. Harvard, Oxford, MD, PhD, and most of us, including me, are not that smart. So let me see if I got this. First of all, there's a big heterogeneity in the population, meaning there's a lot of differences depending on your genetics, your metabolic type, and, and how you respond to different foods at different times. And, and that's really important that there is no one size fits all.

Right.

Number two, that our whole hypothesis that LDL is the boogeyman, but V with a capital T H E, may be starting to see cracks in it, in its theory. That keto is something that can actually help reverse a lot of the broken metabolism that affects us as a population, including across the spectrum from autism to Alzheimer's to cancer, diabetes, and even mental health things like depression and schizophrenia and bipolar disease. This is just kind of a radical idea that there'd be like one quote drug that could treat so many different problems because it hits this simple common route. I'm not sure that cardiologists have caught up to this idea that LDL isn't the whole story. In the subtext of also what you said was that a lot of other biomarkers may be more important than LDL.

Are more important. I would say are more important.

Okay, okay. I was just being, I was trying to be more, more like scientific and say, may, because, because I think, you know, some people still are in questioning this. Like the, the basic orthodoxy is the only thing that matters to measure is LDL. But I am being scientific in so.

Far as that we can quantify the risk associated with different biomarker changes, and LDL is not the most important biomarker. It doesn't mean it doesn't matter. I didn't say that. It doesn't mean it shouldn't be treated in certain patients. But in terms of is it the most important biomarker, I feel like we can say no pretty confidently.

Yeah, it's interesting. I mean, you look at insulin resistance, it's six times greater a risk factor for having a heart attack.

Women's Health Study.

Having a high LDL.

I think it's even more. Yeah. I think the, the, this might have even been in a documentary you were in, but you're talking about the women's health study. And I think the hazards ratio for a high lipoprotein insulin resistance score was six plus. Yeah. And for LDL was like 1.38. Yeah. And since one is nil, a lot more than six.

Yeah.

Right. Whatever, you know, 500 divided by 38 is.

It's a lot. It's a lot more. And then Even more is like triglyceride to HDL ratio and Apo B and a lot of other biomarkers, insulin, inflammation, all may be more important than LDL. And yet the thing we focus on is LDL cholesterol because it's what's easy to measure in a lab test at your doctor's office, your annual checkup. And it's easy to give a prescription and everybody feels good and goes home and thinks everything's great. But the truth is we're missing a lot and actually statins don't really treat underlying metabolic function and they actually, I don't think even really help with correcting the quality of your cholesterol. They don't affect the small particles as, and they may produce total particles and they, which may be helpful, but they don't actually improve the size of your cholesterol particles, which happens when you eat a higher fat diet, which is what's so remarkable. And as we come to sort of understand the nuances of cholesterol, and this is why at Function Health, we measure your lipid protein fractionation, we measure insulin, we measure A1C, we measure your your ApoB, we measure LpA, we measure a lot of the things that are not being looked at to round out the picture of what your overall cardiovascular risk is. We even are measuring qualities of HDL, which most people don't think about that.

You can actually measure. That's a complicated sphere.

It's literally sphere. And so, you know, I think we're in this exciting inflection point in cardiology and medicine and, and, and understanding the metabolism and biology, and yet people are still in the old paradigm. You know, I was literally on the phone with the people from the Dietary Guidelines Committee for the US government, and we still don't have a good National Academy of Sciences review of carbohydrates that are up to date because nobody's funding it. And we can give $185 billion to Ukraine for the war, but we can't give a million dollars to the National Academy of Sciences to look at the data on carbohydrates, for example, which a lot of people have been doing outside of the government, but that's not good enough for the government to kind of make changes.

So, right.

We're kind of in this exciting moment to me where we should be really thinking about cardiovascular risk and overall health in a much more broader context of metabolism and, and, and our broken metabolism and how we can actually address that in a, in a coherent way that may, may not have to be so extreme as a keto diet. I, I think, you know, Benjamin Franklin said it well, an ounce of prevention is worth a pound of cure. So if you, if you've got a healthy, robust metabolism, you can tolerate a wider range of degree of freedom in your diet. If you have a broken metabolism, one blueberry might shoot your blood sugar up. Whereas if you're healthy, you can maybe drink a can of Coke and that might not actually impact you that much. But if you did it repeatedly, it probably would. So we had this kind of inflection point, I think, in medicine that I think is happening in the science but hasn't reached popular culture. And I know that's what you're really passionate about, Nick, is getting this message out to popular culture so people can actually take advantage of the science. and it's not sitting on a shelf and we can go from 17 years to 17 seconds to get adoption.

The fact of the matter is people don't need to wait for authorities approval before trying something when it's a dietary therapy. They have access to it. Now, I think people should do it in a nuanced and responsible manner, but in order to empower people today, what I love is exciting people about this metabolic health journey and getting them to engage in the process of what I call like n equals one science on themselves. Where you identify an outcome you want to change in yourself. What do you care about? It could be, you know, improving brain fog. It could be your weight, it could be depression, it could be your GI symptoms. It doesn't matter what it is. Choose your outcome, then hypothesize what might improve that outcome. Like a scientist, create a hypothesis, then execute on that and collect your data. Your data could be something objective, like a biomarker or a weight on the scale. or just subjective data and evaluate the outcome without judgment on yourself, but curiosity with respect to the data, then iterate forever on yourself. That is what is living the N equals one lifestyle. And that is, I think, how every individual, even today, even in the ecosystem with like the food booby traps we have everywhere, platitudes around health, misinformation, if you really adopt that mindset, and engage on that learning journey, you will achieve incredible health results that are beyond your wildest dreams. I truly believe that. I've seen it happen again and again, including in people who don't have any scientific or medical background. One of my favorite examples is, I don't know if you've come across Dave Danna on social media, but he was a guy that I met. Must have been 2022, maybe it was 2023. I think it was 2022, but when I met him, he had poor mental health, depression, was over 400 pounds. and he wanted to improve his lot in life. You can imagine, like a lot of people, he'd tried a lot of different diets that hadn't worked and were just kind of in a place of learned helplessness. But also, like a lot of people, had this fire in his belly to get better. He just didn't know how to direct his energy. So we started working together a little bit. I did honestly very little for him other than give him just a little bit of support, encouragement, and information. But I saw this like flick in him at one point where he got that mindset, where he's like, actually, My metabolic health journey is a curiosity and a privilege, not a chore. And I'll fast forward to where he is now, which is he's lost more weight than I am as a fully grown adult male. I don't know how much weight at this point, but a lot, probably close to 200 pounds. He got his, you know, financial books in order, he incurred his depression, he got married, he finished an MBA. He is just announced that he's going to be a father. Oh, and by the way, just as an aside, he's partying with Arnold Schwarzenegger on Venice Beach and at Arnold's house. becomes such a fitness icon among people that struggle with similar journeys. The point here is I genuinely believe that that's achievable for every single person if we construct supportive communities and encourage people to engage in metabolic health learning and try to meet them best where they are.

That's right. And I think, you know, what I found is you don't necessarily have to go fully extreme keto to achieve a lot of the benefits. mm-, that you could achieve by kind of being more low glycemic, low starch and sugar. And I think that's, that's kind of the key message here is that starch and sugar is the boogeyman. It's not necessarily fat, although there are some people who are, have real significant genic issues around fat. The vegan community has an incredible PR machine.

They do.

It's 2% of the population, and yet there's more documentaries, there's more scientific studies, there's more papers on this. than most other diets. And I don't understand exactly why it's kind of almost a priori assumed that if you can be a vegan, you're going to be healthier, that it's better for you and it's better for the planet. We're going to leave that aside because that's a much deeper conversation. But that's a, that's a very interesting frame that I think has been sort of accepted as a, as a truth in our society, which I don't think has been properly challenged. And I think, you know, your work and Dr. Littlewood's work and others has really kind of shown that, gee, maybe we need to look at this a little more carefully. And the other stream is the carnivore diet. So it's one is like only plants, only animals. And I think there's, they're both are potentially problematic, but I'd love you to sort of unpack a little bit of your perspective on, you know, the pros and cons of sort of a vegan diet versus a sort of a healthy omnivore or even a keto slash even more extreme carnivore diet.

You said something interesting where you said environmental impacts, and we're going to leave this aside for now. I don't want to leave it aside. I actually want to bring it up because I think the reason that there's such a great PR machine around a vegan diet, or let's even just broaden it to say why a lot of people are very attached to certain ways of eating is because Food is such an emotional thing that topics bleed into each other under the surface. So it becomes very difficult when we're talking, say, about a carnivore diet, and I'm like, you know, this actually might be an incredible therapeutic for people with inflammatory bowel disease. People don't hear that.

They hear that I'm saying, Kill the planet, climate change.

Or they create that undertone bleeds into the topic. So they do mental gymnastics in order to negate or ignore or overlook what I'm actually trying to say, which It might be a very precise statement. It might be for people with treatment resistant inflammatory bowel disease, this might make sense as a therapeutic. And so I think it's important to acknowledge that diet touches on a lot of different things, animal welfare, climate change, and that while all these things are important, we do need to parse them in order to have precise conversations where we actually like evaluate the data as objectively as possible. I agree. And I, and I, the reason I.

Say I'll put it aside, cause I've written a lot about, I've talked about, I wrote about in my food book, food, what they should I eat and other books, food fix. And I basically came up with exactly what you said. There's like three basic issues. It's health impact, environmental impact, and it's moral implications. And so those are all separate. If you're morally opposed, there's nothing I can do to really make an argument against you. If that's your core values and belief, God bless you. As far as the environment and planetary issues, there's a lot of flaws in that argument and it has to do with the regenda versus GAO arguments. that again, that's why I wanted to leave that aside. I really want to get into the sort of biology of, from a health perspective, you know, and, and, you know, up till, I think 1940 something, there wasn't a word for a vegan diet. There's no been no historically vegan, vegan populations on the planet in, in, at least who wanted to be vegan. And everybody's looking for meat because it's the most dense form of nutrients. It's the most, you know, nutrient dense, nutrient rich.

Right.

Form of nutrients that you can consume to grow and thrive.

Well, I, I would say by and large, I'm diet agnostic when it comes to metabolic health. And what I mean by that is the great thing about metabolic health is the proof is in the pudding, how you feel in your biomarkers. So if an individual achieves great health biomarkers, disease remission on a vegan diet, I will applaud them and be happy for them. Have you seen that? I've seen people who profess to it. I, I mean, I believe it's doable. I believe it's not necessarily easy. It might require supplementation. I believe it is possible. I don't have any reason to like fully doubt it and I will give that the benefit of the doubt. I don't think it's a fair assumption, which is often a common assumption that eating the higher proportion plant based you can eat the healthier you are. I think that is a problematic reasoning. Again, it comes down to biomarker or not biomarkers, but like, what is the proof? How are you actually doing? And what does a particular dietary intervention actually do to you? So I'll give an example where I can actually construct a scenario where I go from a very saturated fat, rich, animal based carnivore esque diet to a vegan diet and spike my LDL and ApoB. I've done this. I have the video breaking down how I did it. Yes, it's a party trick. Nevertheless, it's again legitimate and resulting in a change in a biomarker that I would say the vegan community thinks is particularly important. Probably LDL. Yeah, I mean that's really interesting. So it's just like throwing the wrench in there of saying, look, There's so much context around this that do whatever you want with your diet, but don't be deluded to think that just eating more plants is gonna make you healthy.

Yeah, test don't guess is my motto.

I like it.

Test don't guess. I mean, look, I can say, God bless you, whatever you wanna do with your diet, do it. But track how you feel, track how your body systems are working, and track your biomarkers. Get data on yourself. Because if you start to get real data, you begin to see, and I've seen this, people who even want to profess to be healthy vegans, I'm not talking about the chips and Oreo cookies and Coca-Cola vegans. I'm talking about people who are trying. They're often more insulin resistant. They often have more lipid particles, smaller lipid particles. They have higher triglycerides, they have lower HDL. They often have lower levels of many nutrients, including zinc, iron, vitamin D, omega-3 fats, iodine, and the kind of list goes on. and, and I measure these things. So I'm not doing it based on some belief or theory. I'm doing it based on just being a, a keen observer of data in, in the population that I've treated for 40 years.

Yeah.

And, you know, it, and even one patient who, you know, was so morally committed to being a vegan, you know, we did her, her anti-malarian hormone, which is a measure of fertility. She's 30 years old, and she was had the fertility levels of someone who was like in her late 40s and she wanted to have a baby. I'm like, this isn't good for you. And here's all the nutrient divisions you have. And, you know, also you look pale and sallow. I mean, you might want to consider changing your diet. And she did.

And immediately she was able to get healthy and get pregnant. All right.

I'm going to tease you before I talk about carnivore. Yeah. Brian Johnson. Is he healthy? That is a great question. I think he says he feels healthy and his biomarkers are I think he, he does what I think most vegans who want to be as, as fit as he is and have as much muscle as he does, he supplements with processed plant protein powders that are most likely spiked with amino acids. Because the, the, the, the concern I have around, you know, people who are, are saying they're healthy athletic vegans is they can't do it on a, a pure vegan diet that you have to supplement in some way. For example, if you want to get, you know, 30 grams of protein, you can eat four ounces of steak with 250 calories. If you want to get that from brown rice, you got to eat six cups and it's a thousand plus calories. And that comes with all sorts of other implications of who's gonna eat six cups of rice and it, you know, what does those thousand calories doing to your blood sugar, insulin and so on and so forth. So, I mean, and they go, we all, but look at in China, they, they eat a lot of rice and It's true. I mean, I traveled around in China in the 80s and I was in medical school at the time. And there were these super fit, thin, athletic looking, lean Chinese who were working in the rice fields 12 hours a day who would come in and eat like a giant bowl of rice and a big vegetable on top. And they were able to do it because they burned through it. I mean, if you're a marathon runner, you'll burn through it. But that's not most people. It's an interesting kind of framework where we have to start to look more at what happens to individuals when they try these things and look at honestly, at their own biology. And that's, that's part of why we co-founded Function Health, which is to give people access to their data, not just having to go to the doctor. Please beg, can I please measure my insulin? Can I please measure my ApoB? Can I please measure whatever?

You can do it. It's your body. You should pick and choose what you get to do with it. One thing you said there stood out to me, which is not for most people. And I think something we both agree on is that like, it doesn't really matter what works for most people if.

It works for you at the end of the day. Yeah. But with that, it's probably a good transition to talk about.

Benefits of carnivore.

And, and, and what are the, like, what are the, what are the benefits and also the challenge you see on terms of the vegan side? I mean, you know, cuz I think, you know, historically as populations, from an.

Evolutionary biology perspective, we've been more carnivore than vegan, right? We got most of our protein sources.

From animal based foods, I think, for most of our evolutionary history. And there are certain populations that, you know, have more plants and, you know, if you're a 40th latitude and you're kind of in the equator zone, you're.

Gonna probably have more plants to eat than if you're in the, Tundra of.

Alaska or somewhere and you're got to live on whale meat and stuff.

But one would also argue that like when we were evolving, there wasn't a selection pressure for like longevity that our priorities as individuals and organisms have shifted. So how far can the evolution perspective really take us in assessing what's best for our health? Okay, let's talk about Carnivore. I mentioned earlier in the pod that I had a very negative view of keto before I started it, but over time I've developed an interest in Probing areas of taboo. Carnivore is definitely one of them. When it came up on my radar, my first response was like, this is absurd. I can only meat diet. This can't be healthy for you. Despite how I'd changed my mind on things before, but I like playing devil's advocate. So it started, I started to dig into it a little bit more. And what I found was that there was actually a lot of basic physiology and biological plausibility. to align with some of the things that people report clinically on a carnivore diet, like remititive inflammatory bowel disease, which is obviously of interest to me. So since that point in time, I've been delving into it as a topic a little bit with respect to, you know, writing case series. We had one on a carnivore diet for anorexia, because that's obviously a very controversial one for a carnivore diet for inflammatory bowel disease, where we're like, you know, we did full medical histories. We had lab reports, colonoscopy reports. and we interviewed, I interviewed like 10 patients and to hear their stories, people saying like, you know, that they had had Crohn's or colitis for a couple decades, been through a litany of immunosuppressants, been through surgeries, and this was the first thing that really like brought them back to life and gave them a new life. Like you can't ignore that. No. Especially when, you know, it's, it's dozens of people. 10 were reported, but there are many more. And then you square that up with physiology that actually makes a lot of sense. Like carnivore is usually keto, ketones in the gut reduce inflammation, higher ketone levels in the gut associated with lower IBD activity. There's even literature showing how fiber elimination can have a therapeutic effect via changing called mucosperillum, I think, a pathobiont on the gut that can put pediatric Crohn's disease into remission. I didn't know before studying it, but.

Actually fiber free liquid diets are quite.

Commonly prescribed for refractory. Yeah, elemental diets. Yeah. Yeah. It's like 60 to 85% of cases respond. They don't teach you that in medical school because it's like it, you know, I guess heresy against the, the beneficial effects of fiber. But say for that particular use case, I was seeing so many stories. And when I say stories, I do mean like with medical histories, lab reports, colonoscopy reports that are just overwhelming along with interesting physiology. And it comes back to this question of or the topic of absence of evidence is an evidence of absence. Like nobody's done the 3 to $5 million randomized control trial of a strict carnivore diet versus a vegan diet for IBD. I have my hypotheses about how it might turn out. I'd like to see it done, but that's the reason this isn't, or a reason it's not prescribed is because the studies haven't been done. It doesn't mean it can't really benefit people. Coming to that realization and feeling it's the intellectually honest thing, then a butts against some of the, what I would call intellectual dishonesty I see in the media and the scientific literature around carnivore diets. I'll give you a case in point. Did you see Jama Cardiology case report that came out about the blacks on the hands, the yellow nodules was over.

All the- the anthomas, you know?

Yeah. So, so there, there was a report that came out, a few weeks ago as we record this, it was in Jama Cardiology. It was a case report of, an individual who went on a carnivore diet and had, they say, cholesterol oozing from his skin if people want to Google it. And there's these pictures of, you know, these yellow plaques on his hands from eating a, presumably a carnivore diet. Now, you look at the report, And it was word limited, but you look at the report and the entire description of the patient was a man in his 40s. That was the description. Didn't even give his exact age. No medical history, no family history, no genetic history. And they described his diet as him eating 6 to 9 pounds of cheese, butter, and beef daily. Wow. Which is actually implausible. So this didn't read like a case report. This read like a skit from Monty Python, you know, like the fat man. I'm like, this is not plausible. How did this get published? Right. I'm all for cautionary tales, but this is intellectual dishonesty. And if people actually do read the report, it was worded a little bit vaguely around his diet. The first author did get on the news. I think it was Fox News and doubled down on the fact that he was reporting six to nine pounds of cheese, beef, and butter intake per day, again, for eight months, impossible.

This isn't a legitimate report. And nevertheless, it does- this is where we all understand, like four ounces is like six ounces is a normal portion of meat. It's like four times that as a pound. You're talking about nine times four. Oh, yeah.

No. I mean, when you go to get a 16 ounce ribeye, no bone, that's a pound. So the least he could eat was six of those per day, every day, the least, for eight months. Not even mentioning the density of cheese and butter. A human being can't eat this. Not even like, I don't know, Eddie Hall or the Mountain from Game of Thrones probably eats this much. Maybe them, but you can see his hands, it wasn't that person. So anyway, this was just one example of what I would call intellectual dishonesty. In order to, if I were to make the steel man, what they're probably trying to do is project a, a conservative and cautionary tale in order to dissuade people from doing something that people presume is harmful. But the fact of the matter is when you have a pattern of reports like these, and there are a pattern, I can go through other examples, what ends up happening is the community of people who have benefited that is their narrative. You're not going to dissuade them otherwise. If an individual's benefit, they feel they've benefited, see this for what it is, intellectual dishonesty, double standards, and then trust is lost. And then that is what's dangerous. Trust is lost in science and medicine. So now, why are they going to believe anything else that comes out of JAMA Cardiology?

Because this nonsense came out and it evidently was nonsense.

That's one of the top medical journals. So it's not like it's some- Happened with Circulation too, with a report where they basically live through their teeth. And in both these instances, there is no actual good recourse. So they don't accept letter to the editors. I tried to do one for a circulation report. They said, you know, it's a case report. You can't actually do an E letter. I emailed the journal, I emailed the first author, no responses. I even told the first author in an email on this journal cardiology report, I said, like, this report seems deficient. If you have more details, I'm willing to help support you writing in the full case report as a cautionary tale. We want a detailed dietary record. If you want to get genetic testing, we can do it at my expense. I'm not against N equals one. I'm not against cautionary tales, I'm not against case reports. I'm against intellectual dishonesty. And there is so much when it comes to meat and carnivore diets, and it just pervades the literature. I was reading a study in neurology about red meat and dementia, and they cited a study where they said saturated fat is bad because it lowers BDNF. And the study was a mouse study where the mice were fed an HFS diet, which stands for high fat sucrose diet.

Yeah.

So they're throwing saturated fat under the bus, citing mice eating sugar. Yeah.

I mean, that's the whole another conversation, which is eating saturated fat in the context of a high sugar carb diet. That's what makes it deadly. And I read a lot about that in my book, Food, what the heck should I eat? I think people admit or even eat back at then. It's like, it's not the saturated fat per se.

It's when you combine it with the starch and sugar, which is mostly how it's found in diet. Right. Milkshake is not a Again, relatively diet agnostic, but I do think there's a systemic bias in the media and the scientific literature against red meat and certainly carnivore diets.

And I like to call that out. So let's just say for some people with severe illnesses that a carnivore diet can be a therapeutic diet. I think the question I have is, is it the meat or is it what they're cutting out? And I, as a functional medicine practitioner, I'm leaned toward more towards it's what they're cutting out. They're not eating gluten, they're not eating dairy, they're not eating grains, they're not.

Eating beans, they're not eating a lot of things that can irritate the gut.

Is it the meat or is it just what they're not eating?

I don't think there's anything magical about meat. So I wouldn't say it's the meat per se. I would say that it's an elimination diet. But if the universe of foods that is an irritant to you is basically.

Everything but meat, does it make sense? It may not be like it, you could add back things systematically. What I would also want to sort of double click on here is the narrative in the culture that meat is unhealthy, inherently bad. It's going to cause heart attacks, it's going to cause cancer. It's bad for you. We all know that it's bad for you. We're all told eat less meat. We're told to eat less red meat. Where do we stand in 2025 on this data?

I think it's weak to non-existent. I think most of it comes from large scale population studies that are skewed by profound health user bias. And then mental gymnastics that people do in statistical manipulation to reinforce the narrative.

That red meat is bad. So, so just to unpack that in English. people who, when they do these large population of studies, the people who were eating meat at the time, and a lot of these studies were done in the seventies, eighties, when meat was the boogeyman, the people who ate the meat were less healthy. They ate more, they drank more, they weighed more, they smoked more, they didn't take their vitamins, they didn't eat the fruits and vegetables. It was a million reasons why they had more disease than the people who didn't. Conversely, those who didn't eat meat, we actually saw, you know, who were healthier, but was it because they didn't eat meat or because they were just healthier? They exercised, they didn't smoke and so forth. We saw that with these large population studies like the Nurses Health Study, where it was assumed that women who took hormones were healthier across the board for brain health, heart attacks, et cetera. It turns out that wasn't true. When we did a randomized controlled trial that was a billion dollars from the NIH called the Women's Health Initiative, where in fact it showed many of the opposite findings because they actually did a proper study, not just look for correlation, which didn't prove causation. And that's what a lot of these nutritional studies are that people quote about meat being bad. They're population studies that don't take into account all these confounding factors that can make it seem like the meat's the.

Problem, but it's really not. I would, just to be fair to my own standards, point out that for some of the outcomes that you'd be interested in, say like a heart attack, it'd be really hard to do a randomized controlled trial in humans looking for that outcome where you just have like a very controlled meat intervention. Despite that, I still think the balance of literature is, is very weak. And you can even see that and you were mentioning you were talking to somebody with, you know, on or related to the dietary guidelines. Like, I don't know if you read a draft of the, the guidelines or the, the data behind the guidelines for, 2025, but I looked through it and they even say there like how weak and limited the evidence is. Nevertheless, red meat is bad for you just perpetuates as a meme because it's already taken on a life of its own to go back to the study that I mentioned before or was mentioning before about the mice fed the like high fat , sugar diet and then having saturated fat thrown under the bus. The broader point of that study was about the media was running with it saying red meat was bad for the brain when, as a matter of fact, there was tremendous health user bias. Unprocessed red meat was not associated with dementia in any way, shape, or form. It was only the processed red meat. And then when you, looked at the physiologic explanations, there was nothing there that was specific to the unprocessed red meat, which were the only place they found the effect. In effect, this study said nothing negative. really about, like, say a steak, nevertheless it got presented to the public as don't eat red meat because it's bad for your brain. Instead have a cauliflower because we can take this nice sagittal section and make it look like a brain and, you know, feed into your base human emotions.

Right, that's amazing. So, so your, your take is meat as a whole isn't the problem when it comes to our health.

No.

And, and metabolic health isn't by eating more meat, it's broken by eating more sugar and starch. By and large, yes. That's kind of the bottom line here. And then what, what we're finding is that across a whole array of human diseases, we've been listing again from autism to Alzheimer's, from diabetes to depression, from cancer to, you know, colitis, there may be some common link here that we have missed. And this common link that you talked about is the root. And I think that's when you talk about metabolic health and when I talk about it, that's really what we're referring to is We have a society where we have a massive metabolic health crisis.

Right.

And, and it's not going to get fixed by limiting red meat or by eating more vegetables. I mean, it's going to be fixed by addressing the massive amounts of sugar and starch in our diet. And that's kind of a forest for the trees.

You know, we don't want to lose the forest for the trees. I agree. And to that extent, speaking about forest and plants, I just want to be very clear. Me saying a carnivore diet can be beneficial for certain people and red meat's not bad. is not saying all fruit is terrible for you in all circumstances. Fiber is bad for you. Like these are consistent ideas and I think people get so captured in one camp that there are presumptions based on unrelated statements. So red meat, not bad for you. Red meat can be a health food. Does it mean Brussels sprouts are poisoning you or broccoli is a conspiracy? No, it does not. If you tolerate those foods, I think they're perfectly fine.

And in fact, I'm quite jealous. I love Brussels sprouts. They just don't agree with me. So, yeah. So, Nick, what is next? on the frontier for you. Like you're about to graduate Harvard Medical School, you've got your PhD, you know, what is the frontier in terms of your intellectual pursuits that's next and what's exciting for you?

This will be the first time I probably announced this on a platform of this size, but I took the very big step and decision of deciding I'm not going to apply to medical residency. Now, you know the weight of that, but just to clarify it for other people, if you don't do a residency, you're not a practicing clinician. So I have spent my entire life imagining being a practicing clinician and doing everything by the book, which means getting into the best college I can, best grad school I can, best medical school I can, and I've basically done all that. And then you, you know, go to residency, you go to fellowship, you run a lab, you you know, do everything in a nice professional academic Jade Tower manner. To give that up at this late stage is a big deal because on the one hand, people could say, like, well, what was the point of medical school for you? What I've been thinking a lot about is I observe from my interesting vantage point as a patient, medical student, training to provide health care, a scientist and a young person in social media, what I've observed is that I think the biggest impact can be had from empowering individuals with knowledge about metabolic health and finding innovative ways to fund groundbreaking research that is not going to come from normal channels. I'm not going to get $10 million from the NIH to do the study I want to do. And I've seen people try to change the system from the inside without major success. So what I've decided I want to do is try to, after graduation, scale up the early efforts that I've been making with respect to the social media education, Metabolic Health Education set a, you know, grander scale. The last year for me, starting around New Year's 2024, was just experimenting with how people responded to some of my communications kind of in my free time on the side of medical school. And I think the response has been tremendous publicly, but also on the back end, it has been really incredible to hear from certain parties who are interested in, say, giving $5 million for a particular trial because metabolic health is touching so many people's lives. Some of these people have resources and they'll support you. So for me, it's about finding a way going forward to stimulate conversations, get research funded and Put people's data in their own hands, knowledge in their own hands so they can start their health journey today while the system as a whole hopefully slowly changes. Yeah. Yeah. No residency for me. You know, you're right. I, I literally just read to the.

To what you're talking about as a, a woman who, a wealthy woman in her, in her family who had a son was bipolar. He cured himself through keto diet. Uh, they became very interested in this, created something called metabolic minds, which you mentioned.

Yeah.

And they just funded over $3 million with Mayo Clinic to study keto diets for mental health. Yeah, which is, I think, revolutionary.

The Bazooki family, they've been very nice to me. And yeah, they're a great example of someone who, you know, I would never wish bipolar disorder on Matt Bazooki. However, it's just like I never wish ulcerative colitis on me, but sometimes misfortune strikes the right group of people in order to build a highly motivated army to make change. And I think that's what's happening with metabolic health. And that's why I'm so optimistic is because on the one hand, it's a David and Goliath scenario where big pharma, the current medical infrastructure, biomedical infrastructure, like the incentive structure, business models are set up to favor pills and procedures.

Yeah.

And an unhealthy food environment. However, there is a growing group of people who are just finding incredible success with metabolic health approaches and then unionizing and coming together with albeit, you know, individually maybe fewer resources, a purpose that is so powerful, I can't imagine things don't change dramatically, but they're only going to do so if we really lean into it. And so that's what I'm committing myself to. It's not because I don't think Western medicine has its place, that I don't think it's important. It's that because over the past year or so when I'm sitting in that intern room doing my intern level tasks, asks. It's not that I don't care about the patient, but my mind is not there. My mind is, how can I communicate this incredible scientific story about nanotubes in the brain or cyanide being produced by our lysosomes or whatever to the general public? Metabolic health, this incredible thing. My mind just wasn't in the clinical medicine. And so I thought that wasn't fair for me, the patients who, or whatever, you know, a member of my cohort, my peers would otherwise have that position in residency that I'm going to try doing something different because it's where my story, my skill set, my passion, and my skills are most geared. Where I genuinely think I can have the biggest impact. And maybe I'll fall on my face, but I have to try.

Well, your life has been the perfect alchemy to get you to where you are now.

I like that.

I think I'm very excited to see what you're up to next because, you know, I've been shouting from the rooftops about metabolic health for 30 years and to have someone with your credentials, with your mind, and with your passion focus on this now, as David and I start to sort of round out the end of our careers, you're coming up strong and it makes me very excited because I think people don't understand this and they don't understand how easy it is to actually fix broken metabolism if you know what to do.

Thank you. I feel like I'm definitely standing on the shoulder of giants and just so excited for the future to come. One thing I will say that will hopefully bring listeners and you some more positive vibes, let's say, is like I've been feeling out just kind of naturally the interest in metabolic health among my generation of future healthcare leaders. And it's incredible. It's like people see my peers see our system is screwed up. Medicine has changed for the worse that patients are suffering and we are not stepping up as a system to help them enough and they're looking for innovative solutions. Yeah. And so I found my peers to be so receptive to the metabolic health message. Actually, I was so concerned about this that before I started at Harvard, I wrote a piece for STAT News that was, Will a ketogenic diet make me a pariah in medical school? And what I found to be the case is behind closed doors, people are so open to these fascinating innovations in metabolic health.

Well, doctors can see, I mean, they can see their patients are not getting better. They see they need more and more drugs. They see their diseases are progressing. It's getting worse as a society. I mean, just since I graduated medical school, it's been a disaster in terms of our metabolic health. And you can't not see it anymore.

So I guess the challenge set forth before me, and I present this not as a, I'm not trying to toot my own horn for what's coming up for me. I'm actually asking for help from everybody listening, which is that we've gone through a lot in this podcast. I'm sure all of you listening caught moments when Mark pulled me back and is like, let's simplify this because you're going off the deep end a little bit. Clearly, I have a lot of enthusiasm for this, and I want to find a way to engage people in the discussion in the way that is practical, functional, nuanced, and I want to scale the discussion. And one of the big challenges there that I think every Buddy who's a public communicator grapples with, I'm sure you grappled with it over the years, is like, how do you compete in this ecosystem of engagement bait in a way that is practical and intellectually honest? I think I've really struggled with this.

Because- you- done a great job, honestly, better than most.

Well, it's, it's difficult because it's like, I know, I know exactly what I'm doing when I eat Oreo cookies to lower my cholesterol. I know the media is gonna run with it. and say, Harvard, Dr. Harvard scientist lowers his cholesterol with Oreo cookies. And I know that's going to create confusion. I also know that, you know, the simpler thing's going to happen when I do 720 eggs, or that it's kind of click-baity for me to do debunked with my picture next to a giant ribeye steak when I'm debunking a carnivore myth. That said, I don't really see another way to access people unless you provide them engagement bait that then draws them.

To the table to have nuanced discussions.

So using Oreo cookie as a case.

In point, okay, you're just staying a little like bait on the hook.

Yeah. So, but, but I'm very transparent about. In fact, in some of my videos, I say, this is clickbait. Let's see how it does. Here's how I engineered this clickbait. But here's why I'm doing it. And so to use Oreo cookies as a case in point, because I was very nervous about doing that.

I didn't just do it on a whim.

I'm like, well, this had a net positive or net negative effect. I genuinely didn't know. Health are on your career. Oh, definitely. Talking about my health. And I was even worried about my career. I was talking about like public impact. I'm like, I really can't see a scenario where someone genuinely believes Oreo cookies are a health food. I don't think like an adult could be persuaded by a thumbnail. And if they can, then, you know, natural selection can thank me, but that's another question. But what resulted was really exactly what I'd hoped and more, which was it drew forth conversations that were incredibly productive. It drew into the fold researchers who were prior, previously not aware of the work, who then started digging down the rabbit hole and finding there's legitimate research here and then investing funds potentially in big studies and doing so. We have one $2 million project I want to get up and running either later this year or next year to like rigorously assess some of our work in multiomics. But, and it accesses clinicians to the point that in the, the months following the Oreo experiment, I was literally getting emails from cardiologists left and right saying, I saw your Oreo study. It put me on a path to learning about lean mass hyper responders and lipid energy model. I realized I had a bunch of these in my practice. Some of them were statin intolerant and I've dropped their LDL by 400 points with sweet potatoes because I understand the physiology. So if anything, it had a, quote, positive clinical impact. If anything, I bring this up because it's hard. I'm sure you know it's hard to like, Put something out there that you know is actually, I'm going to say a little bit, is clickbaity for the purposes of drawing people into discussion and also knowing that there's going to be collateral damage. There's always collateral damage. Someone's going to be confused, somebody's going to be angry, and you just accept that.

And at a point, you just need to. At a point, you'd be like- There's going to be haters and there's going to be lovers, and it doesn't matter who you are or what you say. It's always that way. It's always been that way. And you could, you could You just kind of have to let it roll off your back.

You kind of start enjoying it a little bit. Start playing with it a little bit. I don't know. I had a couple pieces recently about diet coke aspartame and both cardiovascular health and say reproductive health, and you'd be surprised at how vitriolic people get about their diet coke.

Oh, you mean you were coming out against it? Oh, yeah.

Saying that there's harm? I think there is. I will probably never drink a diet coke again.

Well, give us this, we're going to about to close, but I want to hear the snapshot. Because, you know, for example, Lane Norton, who's, you know, well respected nutrition scientist and who, who sort of certainly has a following. He's basically says all the data about artificial sweeteners is garbage. Now, when I looked at some of the papers that he was citing, it was like funded by the American Beverage Association, otherwise known as the American soda pop Association, before it changed its name.

Yeah.

I'm like, I'm not sure about this. So what's your, what's your thumbnail perspective on Artificial sweeteners, give us the down and dirty.

I think it's first important to acknowledge getting rid of artificial sweeteners in particular, say like aspartame and sucralose costs you nothing. You like the taste, but it's not like saying cut out red meat or something that might have a health benefit. There is no clear health benefit.

Well, well, you could say you're eating.

Less calories as a way to lose weight. You're not eating less calories though, unless you have the binary of it's a Coke or a Diet Coke. And I hate that binary. People are like, is it worse than a Coke? I'm like, why are you choosing between these two things? Right. Like if that's actually your binary, like.

Arsenic or strychnine, then you can choose.

The lesser of two evils. That is a legitimate choice. And my thing is not to say people shouldn't have Diet Coke. It is here are the data, make an informed decision like a freaking adult. If you want to slam Oreo cookies and eat milk chocolate for the rest of your life, that's a different story. So what I would say is there are really interesting data showing potential high impact harms, like transgenerationally inheritable anxiety. So there's a paper in PNAS, ironic because it sounds like penis, but it was an animal model paper, mice, and I'll explain why that is totally legitimate in a moment, but where they fed mice the equivalent of two to four diet Cokes for humans in aspartame. Not only did it generate anxiety on behaviorally validated tests, but it was a transgenerational effect. So the offspring of the mice and even the grand offspring to epigenetics.

Effects.

Yeah, presumably. So past, in this case, we're looking at the male lineage, but there was anxiety in the offspring and the grand offspring, even though they'd never been exposed to low dose aspartame because their fathers and grandfathers had been exposed. So, you know, and, and there's, you know, physiologic explanations for how this might work, how aspartame also might affect brain health, how it's breaking down, how it changes amino acid transport to the brain. We can get all into all that and also human data on, quote, say, irritability, including randomized controlled trials. So there's some signal in the human literature for sure. It's not the most rigorous of all time study, but then very concerning things in the preclinical literature. And the thing that people tend to do, the diet coke defenders, like perverse Avengers or something, they tend to do is they put up a very implausible bar of evidence. So let's take the example of this, this study, this PNAS study. What it's saying is in mammals, low dose aspartame, the equivalent to what the FDA says is totally fine. It's like 7 to 15% what the FDA says is okay. 2 to 4, 8 ounce Diet Cokes can cause anxiety that is transgenerationally inheritable. You can ask, well, oh, prove this in humans. I'm like, you're really going to try to do a 50 to 60 year randomized control trial where you give human adults Diet Coke and then track it. It's never going to be done. It's never going to be done. And so you're asking for evidence that can't be collected. And I'm not saying the evidence is entirely watertight. So another paper just came out, and I think it was cell metabolism on aspartame and cardiovascular disease. And what they showed in mice and also they had some monkey data was that it can spike glucose and insulin. And what this did was increase plaque progression in susceptible mice, admittedly susceptible mice. However, the mechanism had to do with increasing Certain molecules on the endothelial lining. Basically there were like baseball gloves for rolling around immune cells, the baseball that sucked them into the arterial lining and caused plaque to grow. So there is a very clear physiological model with data in mice and primates showing how this could negatively impact heart health in conjunction with associational data saying artificial sweetener intake is associated with cardiovascular disease. Does this prove beyond a shadow of a doubt that diet Coke causes heart disease? No. But you shouldn't need those data to incorporate the existing literature, which is of concern into your individual algorithm of whether or not you want to make the decision. So, and artificial sweeteners, to be clear in humans have been shown to cause insulin resistance. Sometimes it takes longer than a day or so. There was one study out of the Weizmann Institute, I think it was in nature, where they showed that it was saccharin in this case caused insulin resistance by changing the microbiome. In this case, it was a majority, but not all people had a response. There might be individualistic elements. It may take time to result. The data are not absolutely proven without a shadow of a doubt, but there's enough there to say this is concerning. And then there's the cautionary principle. Where do you put the burden of proof? Is the burden of proof defined the implausible study that proves it without a shadow of a doubt? Or can you just say, you know, these literature are concerning enough for me to be like, I might be okay with freaking water.

Well, do you think for, to speak to that, I mean, with this sort of new administration and the desire to sort of take chemicals out, do you think that should be a target? Because right now it's kind of considered a grass substance. It's generally recognized as safe. The FDA doesn't really regulate it other than saying food companies, well, do you think it's safe? They go, yeah, we think it's safe. And they, okay, if it's safe, we'll have it.

And there it goes in the marketplace. That's kind of how we do it with, with chemicals in, in our food supply until we find out They're probably... It's funny because you actually hit on a broader point about this burden of proof. Because if you don't have evidence to say this is very harmful, and sometimes the harms manifest over a long period of time, then should you be allowed to introduce a substance into the food supply? And the fact of the matter is, right now the way it is, the answer is you are allowed.

You are allowed.

And then after the fact we might.

Do some first ask questions later.

Right. So let's say just playing with random numbers here, there's only a one in 100 chance that any given chemical actually that is not proven to be safe over a long period of time is harmful. Well, if you introduce 10,000 chemicals- and.

They'Re all- are they all synergistic? Right.

And so we see that with a lot of things. My position is we do live in a society of free choice. So I'm not for restriction of most things. I'm more about better education. So I think we can talk about these things. I don't think Diet Coke should be outlawed.

I think- well, listen, when I was in South America, I was so shocked to see on the Diet Coke can- yeah. A warning label for kids, say this is harmful to kids, it can affect their behavior and da, da, da, da. I was like, wow, this is really interesting that they think there's enough data to kind of put a warning label on food. And I think that's what we should do in America, is we should at least meet the standards of other countries, like those in South America and Europe that put warning labels on where there is some caution.

Yeah.

If there's a concern and not put the burden of proof on the person who's eating it or the government, but put the burden of proof on the companies making these products and introducing them to the country and into our food supply. That's what I'm concerned about. So we don't follow the precautionary principle. We basically say, well, trans fat, you know, we came out in 1911. It's Crisco, great food, substitutes for butter, blah, blah, blah. Better than butter, Fleischmann's marshmallow. And I remember all grown up on all that shit. It turns out it's deadly. It killed millions of people. And it took 50 years from the time we knew it was a problem to get it out of the food supply. I think the artificial sweetener story is yet to be fully told, but I think there's more and more signal that it's a concern. And I personally agree with you. It's not like it's a necessary thing in our diet. And I would say if you want something sweet, put a teaspoon of sugar or a teaspoon of honey in it, because no one's gonna put 15 teaspoons.

Of sugar in their coffee.

But you're gonna get that- have you seen some of the coffees at Starbucks? Well, no, no. No, personally, you're not gonna sit at home and put 15 Sugars, 20 teaspoons of sugar, but you will get it when you have processed foods like a.

20 ounce soda or Starbucks coffee. You'll easily get that. Again, informed choice. If you want sweet and say you're like, you know, you, you want sweet without calories, there are better options than aspartame or sucralose. I think you can have, say, monk fruit, stevia, I think are like totally fine. Alulose, I think totally fine. So it's a matter of making an informed choice. In this particular case, I think the sacrifice basically negligible. That said, if you want to have a Diet Coke, just understand and appreciate the data. Don't stick your head in the sand because the impact is potentially large. Genuinely, and this is going to sound hyperbolic, but I mean this sincerely. Say you're trying to conceive with your partner. You're a guy producing more sperm every day. Is it worth it to you? Read this PNS paper if you want.

It's linked on a YouTube video that I'll put out.

I make anxious sperm, so don't do it. I know. It's anxious sperm. Is it worth it to you to risk a potential impact on the mental health of your future children, which you'll never know for sure? Say they develop anxiety, you'll never know if it was your fault or not. You will never know. But is it worth it to you to have those two Diet Cokes per day? Is it? And I would say it's just like, for me, no. If it really matters to you that much, okay, you're an individual, you can make an adult decision.

Your kid's not mine, but I mean, unless it's some evolutionary food that we've been eating for millions of years, I think the precautionary principle is a good idea, whether it's red dye number three or butylated hydroxytoluene or trans fats or aspartame or any of these things that we've introduced that are new to nature that our bodies don't, might yet have adapted to or don't know what to do with and might be harmful. So I'm, I'm, I'm really excited to kind of how you think. I'm excited with your, your, your curious mind. I love your little tagline. Stay curious. I think that's one of the most valuable qualities in a human being.

You even got a tattoo. Stay curious. My first tattoo. I love that.

I love that. My karate sensei and I got matching stay curious tattoos. I love that. My person only. so I think, I think staying curious is key and not having preformed ideas, being open, challenging your assumptions, challenging your hypotheses, asking questions, not, you know, being ideologically driven, but being scientifically driven. These are all really important things as we start to think about how do we take care of ourselves? And there are things that are mostly missing, even from the nutrition landscape. It's all ideology. I'm a carnivore, I'm a vegan, I'm a keto. I'm just, it's like, you know, like, I saw cartoon was like, how do you, how do you know someone's a vegan? They tell you. All right? So I think, I think, I think it's really important that we really have a moment to kind of pause, reflect and go, the science isn't completely settled. Anybody who says it's settled is, is a, doesn't understand science, whether it's about vaccines or it's about nutrition or it's about anything that, that we kind of debate. And we should stay curious and we should start to keep kind of engaging in this dialogue where we're kind of investigating the data, keep questioning it, keep challenging it. Try different weird experiments on yourself like Nick did.

Do not eat Oreos.

It's not my health recommendation. So anyway, great, great, really great, great to talk to you about all this stuff. I feel like I literally, I could talk to you for another 10 hours and we wouldn't even get to the bottom of it. So perhaps once you graduate medical school and figure out what's next on your.

Horizon, we'll have you back.

And Nick, keep up the good work and stay curious. Thank you so much, Mark. Stay curious. Don't forget, there's a way to listen completely ad free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts, and tap Try Free to start your seven day free trial. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out, I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show.

Show.

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