Dr Layne Norton gets a "D" in Lipid Energy

After recording the video you're about to watch, I ran it by a colleague who I trust to give me measured and critical feedback. I half suspected them to say, "Nick, don't post this. It's not worth it." But to my surprise, they said the opposite. Here's what they said, and I'll read it verbatim. Nick, Lane is a patterned bully who it's clear to me is being a hypocrite on several levels here. You should make this more explicit. So, here's me being explicit about 4 of his points of hypocrisy. First, and the most obvious, is Lane is literally trying to sell the message from the front of his tweet to the back of his video that "data over feelings," but actually then makes a direct appeal to feelings as an excuse for sloppy work. And while I'm sympathetic with the situation, I actually agree with him. Data over feelings. So, in this circumstance, I think it's appropriate to get on my soapbox, so to speak, and defend the data that we've been bleeding and sweating for for years, which I think he did a poor job of covering. Point 2: Lane complains consistently that a problem on social media is that people speak confidently but typically know very little. He actually says that people who speak the most confidently typically know the least. And yet he speaks confidently on a topic about which he makes painfully clear he is ill-informed. Point 3: He attacks others for cherry-picking data, flexes about how he prefers to cite randomized controlled trials, and then blatantly ignores the meta-analysis of randomized controlled trials that's directly relevant to the topic he's talking about. He is aware of this meta of RCTs. It's a point that we've discussed, but he brushes it under the rug and pretends it doesn't exist. Point 4: Layne claims to be a thoughtful expert. Virtue signals would actually be an accurate description, given that he never lets anybody forget that he has a PhD in nutrition. And yet he acts as if he isn't capable of processing explicit biochemical answers highlighted to him in the literature and in multiple direct messages. So keep that in mind, and now your feature presentation. Layne Norton recently did a review of some of our literature on lean mass hyperresponders, which truthfully wasn't the worst I've seen, but I did feel it was lacking, at least where it wasn't humorous. But before I get into my feedback on his tweet and video, I want to acknowledge that Lane recently chose to disclose that he made the tweet and video in a particular context. He said his mom was in the hospital and that that was distracting him. So I send my condolences, but respectfully, I think it was a personal choice to be tweeting while you were with a family member in the hospital, and simultaneously ironic that in the tweet and in the Instagram post, at the beginning of the tweet and at the end of his video, he's trying to sell a t-shirt called Data over feelings.

By the way, guys, if you want your Data Over Feelings shirt, make sure you click the link in the description, go to the Biolane store, you can pick it up there. Catch you guys next week.

And then using feelings as an excuse for some errors in his messaging. So take that for what you will. I'm truly sorry about your mother, Lane, if you're watching this, but I do feel it's reasonable to respond on the matter of our data because data over feelings. And for some further context about behind the scenes over the longer term, we, we being myself, my colleagues Dave Feldman and Adrian Sotomayor, we've been spending our time trying to educate Lane in direct messages and via email, answering his questions and giving him the benefit of the doubt that he'd either actually internalize some of the information we provided to him, or better yet, accept our multiple offers to have a conversation with him or our esteemed colleague Professor William Cromwell, a professional lipidologist with over 30 years of experience. He did not take up those offers. Moreover, believe it or not, while he's now commenting on the Oreo versus Statin paper and feeling at liberty to give his point of view, again lacking some nuance, I actually offered to let Lane see a copy of the Oreo versus Statin paper and give feedback before submission, and he dropped the ball on that too. And also a mutual contact asked Lane if he would want to debate me on a third-party platform, an offer which Lane declined, citing that he had not read enough of the literature, which still seems to be the case unfortunately. With that, we'll get to his tweet. The first thing is he actually mis-cites the lean mass hyper-responder criteria, which are just 3 points, they're not that hard to get. HDL greater than or equal to 80, triglycerides less than or equal to 70, and LDL greater than or equal to 200. BMI criteria, he mixes up the triglycerides and HDL and adds a BMI criteria, lean BMI, which doesn't exist. So after mis-citing the basic LMHR criteria and then reporting on the data from the Oreo versus statin paper, namely that Oreos lower LDL more than a statin in a lean mass hyper-responder, he then states that this has led to some people to claim that statins are worthless and LDL is meaningless. And this is something he's not wrong about technically, but the way he presents the statement seems to imply, or at least does not clarify, that the actual researchers pursuing LMHR research are not making such statements. Again, in the short-form and the long-form videos, he doubles down and emphasizes on these ridiculous and problematic conclusions, not specifying that these aren't the conclusions in the paper, they're not the conclusions that I'm making. He's just nut-picking off social media in order to create engagement and have something to attack. So I do find that problematic, especially when we're not only not saying LDL doesn't matter, but we have multiple publications highlighting our nuanced positions, which he could have cited but chose not to. So, that's what that is. Continuing with his tweet, he then suggests I drop acid, which is a humorous typo, I'll just leave it at that. I did get a laugh out of that. Then Lane suggests that it's very unlikely Oreos would drop LDL cholesterol in others without actually specifying the population to which he's referring. I would push back strongly and say in fact it's very likely, at least in lean mass hyperresponders, Oreos would drop LDL. And we actually have data on this, including a 5-patient case series and an interventional trial. It's important to notice the reason I did Oreo versus statin, which I've said again and again and again, is to bring attention to the literature that already exists, including this case series and including this interventional trial, which Lane clearly didn't take the time to read, which was also revealed in his comment to my colleague Adrian Sotomayor when he referred to the 10-patient interventional trial as a case study, which it is not. It's an interventional trial. So clearly didn't read those data. Point being, I did Oreo versus statin because we have data that would have predicted this outcome, and our model would have predicted this outcome. That's why I felt pretty confident in making such a bold prediction and saying a priori, I'm going to do this, I'm going to do Oreo versus statin, and I think the Oreos are going to perform very well. This wasn't a post hoc retrospective. I said I predict this publicly and then I'm going to execute. So yeah, I do think that this response would generalize to other lean mass hyperresponders. And I don't think Lane has good grounds on saying it wouldn't or suggesting it wouldn't. So point being, the point of Oreo versus statin was that it was a clear and bold prediction announced a priori, a bold prediction of the lipid energy model, a model that Lane clearly does not understand. In his tweet, his explanation for how Oreos drop LDL was, "If I had to hazard a guess, in the short term insulin increases LDL catabolism, so perhaps that played a role." I actually agree, it did play a role, but then he admits it's hard to imagine this explains the 70% reduction in LDL. But he then, at least in the tweet, omits any further explanation of what could account for the phenomenon, which the explanation is the lipid energy model, which he touches on in his long-form video, and I'll get to that in a moment. Now, turning to his long-form video, I credit Lane. I do not see this overall as a personal attack and credit him for expressing interest in the video, as you can see here.

The data itself is not problematic at all. I think it's great. I think it's great people are asking these questions.

He's clearly very interested, and I think that's the appropriate response. So applause to Lane for that. That said, he's not very well read on the topic. I'm sorry, but he's not. We have many papers on lean mass hyperresponders, including the interventional trial I mentioned and a meta-analysis of 41 randomized controlled trials. However, he ignores most of the literature, including including the meta of RCTs, which I know he's aware of because we've actually discussed it with the first author, Adrian Sotomayor, in DMs, but instead chooses to minimize the body of literature by emphasizing a cohort study based on survey data and two case reports, which we have. But again, that's only the tiny tip of the iceberg, and he presents it as the whole body of literature, again omitting the RCT entirely. And then he emphasizes and tries to, it seems, discredit the K-Series, saying it's just an n 1. And he makes that point very, very aggressively.

One subject! One!

And then cites and flexes that he likes to cite instead RCTs because they're the gold standard. You see the double standard here. It's an n 1. I like to cite RCTs. Then he just brushes under the rug our meta-analysis of 41 RCTs. Doesn't address it at all. I do find that problematic. You can decide for yourself whether it's a double standard. Now, for his understanding, or lack thereof, of the data. He states that he was stumped and does not think the lipid energy model can explain the data because the triglycerides went down on the Oreo arm, not up.

So the triglycerides actually dropped. They dropped from 57 to 39, I think.

And that this contradicts the lipid energy model. I'll be very brief. He was wrong. He is wrong. This does not contradict the lipid energy model. It is predicted by the lipid energy model. The lipid energy model explains dynamic changes in lipid trafficking to meet energy demands. Emphasis again and again on dynamic. Triglycerides go down in the acute Oreo-feeding setting because insulin stimulates lipoprotein lipase while the subject, me, remains insulin sensitive given the acute nature of the study. I wasn't eating Oreos for a year, I was eating them for 16 days. And since the lipid test is a fasting test, postprandial chylomicrons have been disposed of. So the relative increase in LPL activity from an increase in insulin in insulin sensitive individual, the increase in insulin coming from the Oreos in the overfeeding fasting state, that drives turnover of VLDL that's still in circulation. So, Lane wasn't wrong earlier when he said that insulin plays a role. It absolutely does. That can explain the triglyceride drop. But as he points out, it doesn't explain the change in LDL, which is explained by the lipid energy model. So, what he's missing here is that the lipid energy model is a broader thing than he sees it as. So, he focuses on something, the triglyceride drop, and tries to use it to discredit a model he doesn't fully understand, and then goes back to insulin to try to explain, at least in his tweet, the whole picture. And then says, "Oh, but we're stumped and I don't really, you know, understand what's going on here." In fact, I found it curious. He said he was so stumped he had to consult his PhD advisor, who was also stumped. And I want to pause there and point out that the explanation I just provided is actually directly in the study, right there, if you read it carefully. In conclusion, Lane did not do a terrible job. It's not the worst I've seen. But I'd like to hold him to a higher intellectual standard. I think he'd like to hold himself to a higher intellectual standard. He did project a position that was lacking in nuance, and I don't think contributed to but diluted existing content, and mixed in with some frankly rude attacks on well-meaning friends, per his online persona. So we will see how he responds, if he does. But I suggest that if Lane is truly data over feelings—

data over feelings—

a message he was literally trying to sell, then he'd opt to be humble about his knowledge. And rather than wasting our time asking questions in DMs, the answers to which he's clearly not fully receptive, or at least not fully integrating, he'd just have a conversation with us. I wonder what he's afraid of, or why that hasn't happened, why he declines debates with me. Plus, honestly, it would save him time reading data that he apparently hasn't Red. So sorry if this is harsh. Hopefully it doesn't provoke negative feelings, but even if it does, data over feelings.

Peace.