From Death’s Door to “Fringe” Keto MD PhD - TFP #004 | Nick Norwitz MD PhD

I was over 3.2 standard deviations below mean. Clinically diagnosable osteoporosis.

Geez.

I had the bone density of like a 70 or 80-year-old person at that point in time.

But there's something to be said for fear and panic and this deep urgency to solve your own health problem that I think gets underestimated a lot. And if you're really driven, you can, you can make some real strides forward.

Yeah. I mean, at this point I only had technically a high school education, and it was intimidating. It almost seemed arrogant to try to solve the problem when my doctors hadn't, you know. Why was it so freaking hard for us to get, you know, IRB approval for a retrospective case series on carnivore diet for inflammatory bowel disease? These patients weren't doing any more interventions. We had the case histories. These are patients that recovered. We have good biological plausibility. Let us put the stories out there. Why the blockade?

Just a quick heads up that we did have some technical issues with Nick's track. In a few places, there's a little bit of an echo, and we did some filtering to help correct for it. So with that out of the way, let's get started. Tell me who you are and what you do.

Uh, my name is Nick Norwitz. I'm a PhD researcher from focusing on metabolism. I got my PhD from Oxford. I'm currently a fourth-year Harvard medical student who graduates in May, at which point I'm figuring out what I want to do with my life. I got a lot of irons in the fire. I'm sure we're going to explore some of those, but high level, I've, after 28, 29 years, figured out my life mission is to make metabolic health mainstream. That's something I say over and over again, and I think If I say it enough, maybe I'll figure out how to do it.

I think, I think many of us would say you're, you're, you're on your way to that.

It's a fun road that I'm building ahead of me as I walk, as I walk along the path with amazing people like you and the people I get to meet, including at COSI this weekend. It's just, you know, so fun. It was a big decision I had to make this year. I was in my last year of medical school, or I am in my last year of medical school, and The thing you do after medical school, as anybody in medicine knows, is you apply to residency to train to be a clinician. It was something that I always had in my mind's eye from as early as I can remember. Both my parents are physicians. It was, uh, and is a career path I hold in the highest esteem. And I always, you know, when you, you grow up in that environment, you think of it as the right thing to do. And then the more you get down that path, the more that's enforced in you that this is admirable, the right thing to do. So it was a big decision, um, that I made about 7 months ago to actually not apply to residency and take a risk and start exploring other things. Um, because I think I can have a bigger impact, let's say outside the system from within, which it's a little bit scary, but it was so incredibly liberating to make that decision. I have no doubt it was the right decision for me. And ever since then, I've just been bounding with enthusiasm for so many different projects. The listener doesn't need to take my word for it. You've gotten to see on the inside and behind the scenes, um, some of the things going on and just how happy and excited, um, and grateful I am for, uh, I'll just say our future together. Just a great time in life.

Yeah. You know, it's something that you've touched on in so many podcasts, but that you never have the kind of time we plan to take today to stretch our legs and find out about is I really want to get into the story of what you actually went through as a patient. So as you just kind of alluded to, and correct me if I'm wrong on any of the following, it's not just that both your parents are you know, doctors, you actually have a huge overachieving family. Your whole family is hardcore. And so you made what I would call the, the easy hard choices. So going to, you know, high funk, high Ivy League college, that's kind of like almost an expected pathway. And so it's hard, but it's an easy decision to make. And you're already on that track from early on. When was the first point in which you realized something was wrong with you from a health perspective?

The end of college. So I was graduating Dartmouth, class of 2018, and it was around 2017 when I was 21 years old where I started to have GI symptoms starting really mildly, like just general diarrhea, bloating after eating. But for me, that was unusual. Because actually I want to rewind and talk about something that I haven't really talked about at length. I've told people my GI story, but my health story actually started before that. So I was a very healthy kid by all outward metrics until age 17. So around 16, 17, I got into distance running and I was pretty good to pat myself on the back a little bit. Like at age 17, I was running like 2:45 marathons. I was a built runner.

2 hours, 45 minutes.

Yes.

That's very fast.

Yeah, no. And, and just to kind of like, I'm, you alluded to it, but when I set my mind to something like I'm, you know, 110%, when I was 13, 14, I decided I want to break the school record in pushups. I ended up breaking the state record, when I decided I wanted to get into running, it's like, all right, yeah, it's Boston. It's the winter. I'm 17 years old. It's 0 degrees, but it's Sunday. So it's my 22-mile run day. Then let's go hit the gym after that. So I was pretty hardcore and I got into running and my first year of running was pretty successful. I kept on winning half marathon and marathon age group, like division titles. And ran about 3,000 miles in my first year. And then I started to get fractures. Now, for anybody who runs distance, like you have a young person running that kind of mileage, stress fracture is typical. So it wasn't the first stress fracture that was eerie, but the pattern that developed thereafter where I started to get stress fractures more and more and at lower mileage thresholds, and they took a long time to heal.. And it got to the point where, you know, whereas before I could run, you know, 90-mile weeks, 100-mile weeks before having any sort of joint or bone issues. Then I got fractures at 60-mile weeks, then 40-mile weeks, then 20-mile weeks. It got so frustrating over a period of a couple years that eventually I just said, look, I'm not gonna deal with the frustration of distance running. Let me go cross-train and go to triathlon, triathlons. But in my first triathlon race, which was a sprint triathlon, the running portion is only a 5K. I snapped a bone in my foot in half.

Wow.

One of the blockish bones in the middle of your feet and it just cracked. It was actually kind of a funny story because if you ever look at like an X-ray of your foot, the bones are overlapping such that there's a lot of lines on the X-ray, so you can't always see a fracture. So I got an X-ray and the initial X-ray is like, oh, you're fine. Then I was walking around for a week and I was on a date I had this embarrassing moment where I couldn't get a shoe on after we went like into a pond. I could, I know, look, my foot was just so swollen. So I went back and got an MRI and he's like, oh yeah, that bone, it snapped in half. I'm like, thank you. Been walking around on this on a week for a week. But anyway, and that after 2 years of suffering from fractures compelled a DEXA scan, a bone density scan, which doctors had not wanted to give me for a couple of years. Because I was a healthy young guy. I had normal testosterone, normal BMI, normal thyroid, normal— all markers across the board were dead normal, including lipids, because I wasn't a lean mass hyper-responder at this point. So they're like, you're a healthy young guy. Like, you don't have low bone density. Like, there's no reason to get a scan. But after this break, they got a scan and I had then got diagnosed with osteoporosis. And that's not hyperbole. My T and Z scores, which at this age were the same for those who know the ins and outs, but basically I was over 3.2 standard deviations below mean, uh, clinically diagnosable osteoporosis.

Geez.

I had the bone density of like a 70 or 80-year-old person at that point in time, which, you know, while I didn't have a test before that for bone density, you can intuit I didn't have that all my life because I had never had a fracture prior to starting running. And there was a year where I could run 3,000 miles without fracturing. So that begged the question, what happened to my bones? And that was my first medical mystery. And I—

You feel like you know the answer to that right now?

I have an idea. So this is—

we'll get back to that.

But, but this is exactly where I'm going, where with how the story evolved and you're gonna see kind of this builds into my ulcerative colitis story and, and why I'm so such a thorn in the side of some people. I think it'll, it'll kind of flesh out the background, but You know, I got treated by some great doctors who I think in general, very thoughtful people, but doctors are influenced by their prior exposures, patients they've treated. I mean, in fact, they should be that, that's a reasonable heuristic. So based on the profile I was presenting and because I was a high-performing athlete running the mileage I did, the preliminary diagnosis that was given to me was REDS. Which is relative, relative energy deprivation in sports. It's like a, a sex-neutral form of the female athlete triad where women have changes in their periods, low bone density, and other metabolic dysfunction. So basically high level, they were saying you're not eating enough, so your body isn't able to support bone maintenance, and that's why your bone density is going down. Now, if I had an eating disorder, that would kind of make sense. However, there were some holes in this story, at least as I saw it, bearing in mind at this point in time, you know, I'm like, oh, well, it started when I was a high school senior. And then this is going through when I'm a sophomore in college. So I'm quite young, but even then I'm like, look, I can do a PubMed search of literature first of all. My BMI is normal. It's 21. My testosterone's normal. My thyroid's normal. I have no signs in my lab work or clinically that I'm under eating. I can also tell you as a human being, like I'm not under eating my calories. I'll finish a run and chug a jar of Nutella. Now doctors don't always believe patients. So I think they thought maybe I was exaggerating a little bit. So, you know, you go to the nutritionist, they do that thing where they're like, what's your weight and height? They give you your Harris-Benedict. Formulated, you know, basal metabolic rate and then they say eat X, Y, and Z. So the prescription for me was just to eat including lots of carbs and sugar. When I was in college, I was literally getting calls from a nutritionist saying, have you had your, like, you know, your carb snack for 10:00 AM between your breakfast and lunch of carbs? And I had to be like, yeah, I know I have my like 10:00 AM pasta. And at this point in time, this is also when I'm first developing the GI upset.. So I'm like, my stomach really hurts, but yes, I'll do it. I'll be a compliant patient. Anyway, the, the, the REDS diagnosis never really fit for me. It, it didn't make any sense. Also just order of magnitude. Like you look at the literature and there are women with BMIs of 13 who have had those BMIs for years with better bone density than me. So like it did not explain the magnitude of the bone dysfunction I had. To kind of cut to the chase, I ended up doing some jigging, digging into the, into my genetics. And I, I probably what caused low bone density was a dysfunction. I have a very rare polymorphism mutation in a gene called LRP5. And what that's predicted to do is impair my bone's response to mechanical stress. So, um, you know, like when you load a muscle, your muscle should adapt and grow. Bones work the same way. And if you have a dysfunction in that pathway, then when you run and, and load your bones and have high impact activities, rather than getting stronger, your bones can not rebuild properly or even get weaker. So I was treated for that. Um, some experimental therapies, especially given my, my age.

Do you think the marathons did?

I do it. It makes sense with the timeline as well. Yeah. The gene environment interaction. And when I, backed off the running, in addition to taking some therapies, I had improvements in my bone density. Interestingly, as an aside, there's cortical and trabecular bone. There's like the spongy bone inside the bone, and then there's the cortex of the bone. My trabecular bone improved on the medications I was on. My, my cortical bone didn't, which is typical until I started a ketogenic diet.

Hmm.

I'm not sure why that is. There's now new literature. We don't need to go down the rabbit hole, but with ketones activating receptors like HCA2, which are on bones. So there might have actually been a benefit of ketogenic diet for certain elements of my bone density. That aside, I ended up writing a case report on that. It was my first ever first author paper on my own bone case. And the endocrinologists who were treating me actually ended up signing on to support the case. So I quote turned them to my side. They were very open-minded. It's just a matter of like, you know, I was the one who had the time to go down the rabbit hole. So that was my first—

How old were you when you wrote this?

20, I think. I think it was 20, 20 or 21. But, uh, yeah. So I, you know, did like, uh, you know, um, cross-species comparative analysis of like, you know, sequence conservation and looked at the mouse models and what human data there were on this gene and kind of just compiled what was a case report and a synthesis of the literature. Um, so that was my first experience solving my own health problems. Now, I'm going to pause for questions because that was a long prelude to the whole GI.

No, this is great. Cause I had never heard this expanded story. And for as many conversations as we've had all the way up until this point, I have been very curious about this because I think, I think a lot of times both you and I have variations of this story with what led us ultimately towards the lipid energy model research and so forth, but there's something to be said for fear and panic and this deep urgency to solve your own health problem that I think gets underestimated a lot. And if you're really driven, you can, you can make some real strides forward.

Yeah, no, I mean, at this point I only had technically a high school education and it was intimidating. It almost seemed arrogant to try to solve the problem when my doctors hadn't but you get to that point of desperation and it's a theme. It's a theme that's happened multiple times in my life. It's happened in your life. You know, you don't know what's going on and you realize that you're the one who's most motivated to find the answer. And then you go digging.

Um, and it is worth emphasizing, and I think you'll agree with me on this. Doctors have to make decisions. They have to make decisions a lot. Now, to some degree, they just kind of have to go with what they can best piece together. Because there's a lot of times they're right. Sometimes they're not. And to that extent, you've got to figure out, you know, no one can take ownership of your health like you can. And so you should always feel empowered to try to find out what you can still working with your doctor, but just be aware that that's the reason to keep reaching if it doesn't add up for you.

Yeah, it's a difficult discussion to have because I think one could take away from it the impression that I think my doctors were mistreating me or lazy in some fashion. And I don't feel that way at all. Kind of as you're alluding to, it's, it's practical limitations, like the number of hours it took me to kind of like puzzle this together in my mind. A doctor just doesn't have that time with their, their clinical load to devote that to any given patient. And if it's not something that they've been taught about, like, yeah, your average endocrinologist has not done a deep dive into the literature on the LRP5 gene. Then you can't expect them to come up with that solution. Um, I guess the best you can ever expect from a healthcare provider is they're open-minded. And to the credit of my own, you know, like I said, they ended up signing on to the report with me, even though I can imagine it took swallowing some ego to sign on to a paper written by some 20-year-old kid. If the argument's compelling and they find it interesting, you know, but then they're willing to support them, which is what happened. So I think a lot to their credit, Now I'm not going to say they believe that it is the entire story. Maybe neither do I. And I'll probably never have the entire story. That's fine. But they were willing to seriously listen to me. So as a tangent aside, you know, anybody looking for a healthcare provider, like, shop around. You don't have to go with the first provider that you find. You got to find someone that works for you and listens to you. I think everybody deserves a clinician who like listens to their point of view, irrespective of their medical or scientific background. I firmly believe that.

So yeah, I mean, at the end of the line, at the bottom line is this, the doctors are human. They're human just like we are. They, they make mistakes. And I think we can all agree they're still trying to do right by their patients and, you know, treat them with the best care possible.

Right. Medicine is not a perfect science. It's an art. And the doctors I respect the most are the ones who express humility and listen irrespective of their accolades, because at the end of the day, the patient just cares about like how you treat them. They don't care about your certificates, your degrees. I remember sitting in the office of, of one doctor. I will just say his name is Lyle McCauley. You can look him, look him up and look at his accolades. I remember sitting in his office one day Um, and he was taking a little bit of time to get there. Uh, to his credit, he spends a lot of time with each patient, very caring, and sometimes doctors are late for that reason. So if your doctor's late, it actually might be a good sign at some cases, but I'm sitting there angry and frustrated just at my lot, but I had time to look around the office and bear in mind, this is one of many of his offices. And I just see like all these awards around the office. And then I had this thought. Because at that point in time, I'm like, I have this vision in my mind of, you know, being a scientist and being a clinician and working towards a career where maybe I could have those accolades because yeah, like 19, 20, you kind of like, especially in the environment I grew up in, like my family of 5 has what, 9 doctorates between us or among us, like both my parents are MD, PhD, my dad's a Rhodes Scholar, like you can imagine the pressure that puts on me internally, even if my parents weren't like tiger parents. But the internal pressure that puts on me. But anyway, that aside, I was thinking, I just had the awareness at that point in time, like, wow, I didn't notice it, that notice nor care that this doctor was so accomplished. All I cared about was like how he dealt with me in the room, how I felt cared for by him. And so kind of like thinking, wow, my life mission is to maybe one day have an office with plaques like this. But now sitting in the patient's chair, I realize I don't give a crap about that. Like, that's not how you measure the success or quality of a doctor or a scientist for that matter. There's other metrics you can measure scientists by— H-index, citations. And at the end of the day, those things are useful for optics, useful as levers. We can get into that and social media and media politics, especially some things happening in the last 24 hours, um, where I let myself be used and my brands be used, but they are Hollow, shallow in and of themselves. So yeah, I think that is something that has been sitting and marinating with me over the last decade or so, maybe even from that point in time, but Zach, so your GI, my GI, yeah, you were, you were, let me see if I'm guessing this correctly.

You were probably thinking now that you figured out what's going on with your bones, you can titrate down this, you know, huge amount of food. That you were trying to consume and therefore probably resolve the GI issues?

No, no, I wasn't thinking about that at all. 'Cause I was also mixed in with the culture of college bros who were like, I was still athletic. I was still like training with tri team. We were swimming, we were biking. I'd work out like 3 hours a day. And then you go to the dining hall and the culture is, yeah, you smash those pastas, the pizza, the cookies. And so it was just part of the culture and I didn't really realize the degree to which diet might be taking the toll underneath. And again, my symptoms at that point, they were somewhat subtle. And the idea of say, like going sugar-free just wasn't even in my bank of options. It's like, because you're so ingrained in that culture, you don't even think about this as like, oh yeah, this is a viable thing to try.

It's kind of funny, but I feel like though, and I don't know about you growing up, I wouldn't think of sugar as being related to GI stress. No, I always thought of it as kind of like this thing that, you know, I shouldn't be consuming, but it wouldn't have anything to do with, you know, GI discomfort or anything like that.

You don't really think about that. And also I think by virtue of the way I was raised, I identified as the young fit person who could eat whatever he wants. There was like a point of pride in that, which was exacerbated by college athlete culture, but it was built in even from the earliest age. Like I had never struggled with weight. Although like my dad's side of the family, my brother, my sister, they did, like they went through their chubby phases, you know, had some issues there. But I was the one who was like always, oh yeah, you could feed Nick whatever and he won't get fat. And when you are exposed to that from a very early age, you start to like almost take pride in it where it's like, oh yeah, like Nick, he can like smash all these, you know, we, we, for example, I remember one day we went to Friendly's, uh, it's like an ice cream place. And after having like the little, you know, the chicken nuggets and the french fries, we're looking at the ice cream menu and I'm like, oh wow, that's like a 12-person ice cream. I wonder how big that, that is. And my dad was like, I bet you can't eat it. And I'm like, watch me. It's that like, you know, Sorry to throw my dad under the bus there a little bit, but, and then I ate the 12-person ice cream like happily. And you know, I guess that little anecdote just kind of captures my psychology with respect to food. It's like I was super high energy, super athletic, didn't put on weight, you know, by age 12 I had a six-pack, got some attention from that, from the middle school girls for a bit before everybody else had their growth spurts. That aside, And so, yeah, it was, it was really built into my psyche. And so I don't really, I didn't entertain sugar restriction as even an option, but a GI issue started to manifest and really take a toll on my, my mental health and social life beyond just the physical, because I did get to that point where I was having multiple bouts of bloody diarrhea that was uncontrollable. Even daily. And you didn't know when that was going to happen. You didn't know if it was going to happen when you're in a lecture hall or sitting in an exam, um, or in a romantic situation. So I went from having, say, like no test anxiety to enormous test anxiety, but not because I cared about picking the wrong answer on the multiple choice test in biochem. I was confident about that. But what if I have a flare mid-exam? Um, or, you know, like, why would I go out to a party and potentially like take a girl home when I could have to say, look, I have to split for a minute. I'm about to bleed out my ass.

Like it, and, and not to TMI, but I think a lot of people don't realize this isn't typical bathroom stuff where you're like, well, I'll just hold it for like another hour or so.

Like it's the discomfort of having blood in your intestines rubbing up against You're in enterocytes is another level of discomfort. Like it's not just like holding a, a, a, a bowel movement. It's you can't, it, it burns like nothing else. So yeah, it, and it's not something people talk about because it's, it's awkward and embarrassing. It's like, oh, why would I, I talk about that outwardly, including in the college setting. So I'm like not telling my friends about this kind of thing. I'm just slowly withdrawing and I'm pretty good at faking and compensating, coming up with excuses. So it just kind of goes on like this. Um, but it creates a lot of conflicts. Um, uh, you know, one of the most anxiety-provoking moments in my life was graduation because, uh, I was lucky enough to be the class's valedictory speaker. I'd done pretty well over the past 4 years. And so I had that opportunity.

I mean, not lucky enough. You, you actually have to earn that.

But, but, but think about the position I was in where the, the college, like, we want you to be the valedictory speaker. And I'm like, that's great. Hmm, what if I have a bloody crap in front of 11,000 people? Don't want to go viral for that. So what do you do? Do you give up that opportunity and say, no, I'm not going to do it because I'm scared? Or do you risk it? In that case, in this case, I risked it. Um, and luckily nothing happened, but like, you can imagine the anxiety that was in my belly. Even as I remember walking up to the stage, I had this like gurgle. I'm like, oh no. And I've watched back like moments of me watching, you couldn't see it on my face. Um, and I highlight that just because I was very good at covering it up. Nobody knew, but inside I was absolutely tortured. And then, um, I finished college, went to grad school at Oxford, and that's when things really hit their worst. And I ended up, you know, in intensive care, palliative care, um, started really dropping weight to dangerously low levels to the point that like, can we Can we backtrack for a sec?

Getting into palliative care is not like a, hey, I'm going to just suddenly check out urgent care. That's a very serious step.

To be clear, there's like a difference between— I realize not everybody knows lingo— like palliative care and like hospice. Hospice is like when you have 6 months to live kind of thing. I was not in hospice. Um, and I was put in— they have like wards in the hospitals. I was put in a palliative care ward in part because, and this is another commentary on just the stress of the the NHS in the UK, but just like bed limitation. But I did spend, I remember this one, uh, series of nights I spent, I think it was, if I remember correctly, October, November-ish time of 2018. Yes, 2018. Um, where I had 3 days in a palliative care ward in the John Radcliffe Hospital, um, in Oxford and NHS. I was the youngest person there, at least by like something like half a decade, half a century.. There were people dying around me, a lot of buzzing and worrying, people with dementia screaming to the point that I couldn't sleep for 3 days. It was absolutely torture. In fact, it's probably one of the most terrifying experiences for my mother, who I was kind of like in and out. I had a lot of brain fog too, but I remember her flying over from the United States just to see me. And like, that's something that I'll never forget, like how ripped up she felt seeing me in that place because like, bear in mind the imagery or the image she would've had of me. Like, you know, I was a high-performing academician. I was always athletic as a kid and now I'm like sitting in a hospital ward bed. We're not sure what's going on. My heart rate's literally in the 20s. Um, actually we had this moment. Um, there's a picture I float around of the, uh, the telemetry. And the, um, the heart rate monitor on the screen sometimes, because I don't have many pictures from this point in time. You can tell why I wouldn't be taking selfies, but where the heart rate is 30. The story behind that picture was it was during the 3-day stent and, um, a cute nurse came into the, um, the room and my heart rate jumped from the 20s to hit 30. And so we took a picture as a joke. It was like, hey, look, you're responding. Now you're in the 30s. You got a little testosterone left. So it was a light moment of humor in a very dark time. That's the story behind that picture. But they then ended up discharging me with the most ridiculous diagnosis I've heard of in my life, which was turmeric toxicity. The spice, you know, the spice turmeric.

Yeah.

So I was taking curcumin at one point, which is the active component in turmeric at 1.5 grams twice per day, which is like a standard nutraceutical that you can kind of take. Maybe it'll help. Very standard dose. And they had found like one esoteric case report of somebody like hyperdosing acutely and then having bradycardia. Not like that severe bradycardia. My heart rate was in the 20s, but they're like, oh, well you're athletic and you're taking a turmeric supplement, so that's probably why your heart rate's in the 20s. So you can go home. 'Cause we've done some, and at that point in time I was just like, Fuck this. You're not helping me. I haven't slept in 2 days. I just want to go back to my apartment and sleep. So I just went there and I lay in bed for a few days, including my 23rd birthday. And, um, yeah, that's where I was at in life. And that was the point in time where I'm like, look, I'm desperate enough to try whatever. And so I started trying things. Lo and behold, a ketogenic diet transformed my life. And at 23, at, it was, yeah, it was 23. It was June 1st, 2019 was the day my life changed on a ketogenic diet. I started it. Now bear in mind, by this time I had tried like many other diets, low FODMAP, specific carbohydrate, Mediterranean, pescatarian, vegan, vegetarian, Whole30, whatever before I tried keto. And then yeah, ketogenic diet within a week, I was feeling so much better. My energy was up, my inflammation markers were down, and then the next biopsy I got, I had no signs of disease in my colon. So that was my medical story and what got me interested in metabolic health.

Now here's a little tidbit that I know, but a lot of people don't know. You saw that your cholesterol skyrocketed. You didn't find me right away.

Mm-hmm.

In fact, you have published a paper, probably a little-known paper, only to a few of us already, specifically on cholesterol, just like you had done before with your first, first author paper. Yeah. You already had some opinions on cholesterol. You wanna tell us a little about that paper?

Yeah, it was a paper I wrote with a, a, a clinician, a friend of mine, my doctor at the time, Dr. Vivian Lo, who some people might know. She's, floats around social media a little bit, but on, why basically my lipid panel might not be telling the whole story with respect to my response. We went over some of the details of my diet. Now, my ketogenic diet to start was pretty low saturated fat. I didn't really eat dairy or red meat. It was actually lots of greens and fiber. I had some IBS symptoms that I think were related to the fiber at the time, but like it was sufficient to put my disease into remission. So it was fatty fish and lots of greens and olive oil. And my LDL still jumped from something like 95 to, I think it was 321. Don't hold me to that exact number. You can see the paper, but there were other interesting changes as well. Like the fact that when we got an NMR, despite my LDL over tripling, my small dense LDL actually went down and I was pattern A to start too. So the entire driving force was an increase in say, you know, large fluffy LDL. And yeah, despite over tripling of my LDL, my small dens actually went down. Like, that's interesting. So we kind of did an analysis of, of my markers at large. And bear in mind, this is like very early on in exploring lipids, so I don't stand by everything I said in that paper, but it was, I forget what the title was. It was something to the effect of like standard lipid panel is insufficient for you know, analysis of patients on a ketogenic diet who is lean or something like that. I forget. But yeah, that was, that was my first foray into exploring lipids. And at that time, you know, I was, was like you very thirsty to figure out, well, what's going on here? Because this doesn't fit anything I can find in the literature. Like, why would I have this response? I don't have FH. I, I knew that, like I'd never had high cholesterol in my entire life. It's been pretty low on a, on a standard mixed diet. And I wasn't even eating much saturated fat or cholesterol. In fact, when I cut out saturated fat and cholesterol, my LDL went up. So what's going on there? So I started becoming kind of curious about the lipid element, which just, you know, I was shocked arose from the dietary pattern I was eating at the time because you looked at my plate and if you show that plate to any like standard physician, they'd be like, this is a totally heart-healthy LDL-lowering plate. And yet my LDL was on par with someone with familial hypercholesterolemia.

And if I'm not mistaken, at this time, this exact moment in time, you had some presence in social media, but nothing, nothing close to like where you're at now. You, it was just modest engagement.

I don't think I even had any social media.

Yeah. That wouldn't surprise me because you obviously, um, Even at that time in 2019, you could pretty quickly bump into my name and high cholesterol and low carb in the social media sphere of low carb, right? But you, like any other med student, were hitting PubMed. You were, you know, just doing a search through low carb and high cholesterol and what was out there.

I definitely had no YouTube, Instagram, or, you know, presence. I had a Facebook, which everybody has to, you know, not forget people's birthdays. But that was the only purpose. And I, I don't think I started tweeting until 2020. Um, so no, I don't think I had any social media presence whatsoever. Uh, I was not someone who, let's say, felt highly of social media at the time, and I thought I had better things to do, uh, including working in the lab, reading PubMed. So it's interesting where I've come.

Oh yeah. The tables have turned.

Is, yeah. Yeah. This is my, my life has taken an unexpected twist, but no, I didn't have social media.

So you get on Twitter, you're bouncing around, you're, uh, I've told this story a million times before. I know that our first interactions were on Twitter and you quickly grokked the lipid energy model and you were starting to ask all the right questions. I was like, oh, this guy, this guy knows what's up. And very rapidly that moved into more and more conversations between us online.

Yeah.

But you also were a very busy guy. I remember at that time going, man, this guy's got a lot going on. And, uh, but at that moment in time when we were interacting, I was hoping to find somebody who would be like a good research partner to help me move this into the literature because I myself, I'm not in it. I'm, and I don't want to write papers. I'm not going to, you know, be at those levels very quickly. So Eric Westman told me a long time ago, long before I met you, you need to find somebody young and hungry, right? And I, and I couldn't have sketched out a Nick Norwitz at that time because you're, as, as you've already revealed here, and as anybody who already knows you knows, you are, you are the hungriest of just about anybody I know when it comes to, just as you outlined, when you want to do something, you're going full send, as the kids would say. Right. And so sure enough, because of how much both brilliance that you had and energy and drive and motivation, I was already trying to kind of like steer you in the direction of the lipid energy model. And I don't know how much, I don't know how well you remember this, but we had already started getting this going. The first LMHR paper with Dr. Tro, and he was looking to pull you in, but you had already kind of had your plate full with the carbohydrate insulin model and connecting with David Ludwig, which of course is a gigantic opportunity. Yeah, sorry.

No, I, so there's one more, one more seed I wanna plant and, and make sure not to look over it, which was the, the third member of the trio, Three Musketeers, Adrian. So before, even before, I mean, the carbohydrate insulin model connecting with David Ludwig, that's when I started, you know, on social media, on Twitter, you know, before that, like I said, I was at Oxford, I was sitting in the lab even before I started the ketogenic diet. There was this unique PhD student who was already a clinician over in Mexico named Adrián Sotomayor, who was a year above me., in my PhD, uh, at Oxford. So we were in the, the Clark Lab at Oxford in the Department of Physiology, Anatomy, and Genetics. And I remember like we'd have like an exercise phys lab and sometimes I'd go in and he'd be doing these weird self-experiments, including one I remember he was, um, like pounding down like walnuts. Um, and, and I was asking him about an n=1 he was doing and he was saying, oh, like, you know, this, this time I'm always, it's time of the year I tend to do keto.. And at that point I, I didn't know much about keto other than what's on the front of magazines. And I'm like, oh, that's interesting. Like you're eating a lot of walnuts. He's like, yeah, well I always need to increase my calorie intake like by 500 or 1,000 to, you know, maintain my weight. And I remember just looking at him like, nah, because I, at that point in time I had a very like basic calories in, calories out mindset around physiology. And he is like, oh yeah, I always need to increase my calories by like even sometimes as, as much as I think he said 1,500. Calories when I go keto to maintain my weight. And I was just like, this guy's crazy. This isn't a real thing. But you know, you plant those seeds. So I never heard that.

I've never heard the story either.

So the, oh, oh, there's, I mean, there's levels of shame to it. Maybe that's why I don't share it because I also used to love to bake. Remember at this time I'm trying to get like, you know, my doctors are still trying to push me to like put on more weight. So I'm pounding sugar and I'd make these like absurd sugar-filled like 7-layer bars with like, you know, condensed milk, multiple types of chocolate. And just being the friendly baker and labmate I was, I'd bring them to Adrian, not realize the degree to which I was poisoning him. Although he was always very grateful. It's, you know, surface.

I do, I do wanna interject this one thing because I think for people who are listening to this who may have struggled with weight, I, This is something else we have in common. In my 20s, I was a rail, and in weightlifting they call this a hard gainer. Yeah. As in, you might actually be trying to be athletic, you might be trying to get muscular, but the problem is you just can't seem to put it on. So it's actually advised that you consume a lot more. And even then they would say it's a good thing for you to get your insulin way up cuz it's an anabolic hormone. So yeah, pound it down. See if that gets you bigger. There was even, I remember this article on a hard gainer that found out that he could gain more by eating right before bed.

Yeah.

And so that was a protocol that he had.

No, for sure. I mean, it, it's a genuine, some people like joke around about hard gainers. Like they're not a thing. Like I'll tell you, it's a thing. It's definitely a thing. Like, yeah, try being, having a BMI of like 20.5, eating 5,000 calories per day until you're sick and then just like, getting on the scale after a couple weeks and it was like, you've gained 0.1 pounds. It's kind of demoralizing. So I was a hard gainer. Sorry if that makes people pissed off. But yeah, I ate a lot of sugar and I shared a lot of sugar actually. For people who don't know, like I love to bake. I still love to bake as an activity. So it was something I did throughout my entire childhood. I literally had a club called Baking for Bears where we would like go to supermarkets and sell homemade baked goods to send to the World Wildlife Fund for polar bear conservation. That was something I was kind of passionate about as a kid as well. So yeah, I sold a lot of sugar during my adolescence. So I guess you can call what I'm doing now karma.

So back to Adrian.

Okay, Adrian, you're, he's having a long— introduce him to, to the story. 'Cause like in, in terms of like how this is all developing in my mind and my exposure, you know, there, there are seeds planted along the way. So by that point in time, I had, I had met Adrian. I did not realize what a staple he would become in my life. For those who don't know, like he really, has been, I'm the oldest of 3 siblings, but he has been my big brother for ever since I met him. Um, like when I moved to the UK and I spent all that time in the hospital, I literally remember the first time I was in the hospital, like, who's your healthcare proxy? And I'm like, my mom. And they're like, she's in the US. You need like a local healthcare proxy. And I'm like, uh, hey Adrian, I know we just met, but I need a favor. Yeah. And you know, he'd bring me like my computer and PhD work while I was like in hospital beds. And I just kind of had to be vulnerable with someone and I entrusted Adrian and ever since then we've been—

he's the sweetest guy.

He's so caring.

Um, he's also, he's also super optimistic. Just constantly.

I mean, you know, I'm, I'm doing a gesture here for people who aren't listening. You know exactly what I'm thinking about.

Yeah.

With the neck collar?

Uh, no, during the, um, the first, oh, I know where, yes, I know where you're gonna go.

You know what, we should, we should save that cuz this, I'm gonna let you break it cuz I'm just talking so much.

Yeah.

I can need a little balance. I wanna tell that story.

No, but this is good cuz it's, it's, I, I, I like this full introduction into the timeline because this is the first time we've ever been able to really go over not just your timeline.

Yeah.

But I've not, I never got this backstory of you connecting with Adrian before meeting me. Oh yeah. I mean, I knew you guys met at Oxford. I knew you guys became super pals at that time. And I knew at the point, I know I kind of jumped ahead to where Tro was wanting to connect me on the LMHRR paper and seeing if he could pull you in. You would then say, oh, we've got to get Adrian in for the math, for the numbers. And so I didn't know much about him and I was kind of surprised I didn't know much about him. I was like, oh, well, I feel like I kind of know all the biggies in the low-carb world. But yes, you'd already had this rapport with him. You had already been, you know, tight from Oxford. And when he got brought in, I was, I was just like, wow, this guy's super brilliant. And he had his own story of when he discovered me. And like so many others, I, I take this as fun self-deprecation. He was like, this guy's out to lunch. And did his own Feldman protocol and then found out it worked on him as well. And that was the point at which he was interested in getting engaged in this research. And pretty much it's the 3 of us just locked in. We, I mean, don't get me wrong. We have so much thanks to give to all these other senior authors, including David Ludwig and so forth. But yeah, that's, that was that was a cathartic moment for me because I felt like when the three of us started really working through this, it, it hit this new stratosphere. It was a big deal.

I'm now just thinking, I wonder when I was having him, watching him eat those walnuts, um, I wonder if he was doing a Feldman protocol and just didn't name it.

That might be funny. Maybe that was, maybe that was the, that was the—

that'd be funny. Adrian's a man of few words, so sometimes he just does things. Like if, if you don't ask him a direct question about something, he won't like reveal it. Like we were really good friends. I remember we were out to dinner one day. Um, and like somebody else that was with us asked about his wife and I'm like, you are married? Or, or how do I not know this? And he's like, well, you never asked. I'm like, you, you volunteer this information at some point in time after like a year of friendship or something. You go out to dinner, dinner, like me and him, I'm like, hey man, you wanna go out to dinner tonight? I'm like, If you have like a local spouse, I just figured you'd check with them.

He's like, oh yeah, you know, this is the same thing with, if I'm not mistaken, this is the same thing with you finding out he's a freaking full professor at 35. Like he's not running around bragging about it. He's super humble, but it's totally bragging material. He's, he is, I like to call it the humility index. He is way more humble comparatively to his accomplishment degree. Than I think anybody I know.

Yeah. Like, no, it's— in fact, this is a fun fact about Adrian that he would not like me sharing, so I'm gonna share it, is, um, in Mexico there are like national exams to get into the, um, one public medical school. It's very competitive. Uh, I forget how many people— we could Google it— how many people apply and take the exam. It's something like, it was like 10,000 or something that, uh, I don't know, or more, probably more. Who take the exam. Do you know how he ranked in terms of score?

Where?

Number 2.

Number 2. And geez.

As, as, as far as I'm aware, I'm not gonna name names, but, um, I don't think number 1 finished their medical training for other reasons. So he was number 1 to, to finish. Anyway, like that was just like an aside that I forget how it came up. I think I asked him point blank cuz I had a suspicion and he like sheepishly after I twisted his arm, like mentioned where he like ranked nationally, which is He's, he's, he's a bona fide genius, I think.

I, I think so. And he's gonna be in this podcast at a certain point.

We're working out the timing, but, um, so if you want any like random fun fact, like we'll sit like a, I don't know if we were talking about chess. I remember he was at our, um, like at my house at one point in time, but we'll be just like talking with my parents about something related to chess and he'll like know the entire history of like grand chess masters, like esoteric things that are even beyond just science. He is an absolute sponge of diverse information. Yeah.

So the, so to complete it for the people who you were making this gesture for, go ahead. In the course of us publishing one of our papers, the timing in this case doesn't matter so much as it's, it's demonstration of his dedication. There's that running statement you often make where it's like, well, just in case, say you get hit by a bus, we need to be able to have a backup plan for XYZ, right? Well, He's our math guy and lo and behold, at a certain critical point at which we needed to get some, I think it was during, uh, revisions, revisions, right? We needed some corrections that only he could do. I mean, when I say only he could do, like we couldn't have even found somebody to sub in. He literally had gotten hit by a bus and was doing it from his hospital bed with a brace on. And when we, when we opened the Zoom to chat with him, he was just ear to ear smiling as he always is, just, just blowing off this incredibly traumatic thing that had just happened to him. Yeah. Because that's just his spirit. He's, he's an incredible guy.

Well, I wouldn't have even known about, if he didn't have to be wearing the neck collar, we wouldn't have known because I said, Adrian, hey, we need to talk about these edits. Can we get on a Zoom call real quick? He said, sure, give me 10 minutes. That was it. And then we got into Zoom and I'm like, why are you in a neck collar? He's like, yeah, I got hit by a bus.

Yeah.

And he showed me a picture of his, he was in, uh, an Uber in the back and a bus had just slammed into the back of an Uber. And I like saw pictures of his, his imagery, like his images, his medical images. Like his neck was broken. Literally his neck was broken. He didn't even know the prognosis. And he's like, yeah, I'm happy to do this. Like I need a distraction anyway. Just smiling ear to ear. And then like we continue to work on other projects thereafter. When he can't even sleep laying down for like months and he's carrying a clinical caseload, he's like, I just have to be careful walking through the hallway so nobody bumps into me cuz now I'm in this neck brace. And he's like, oh, I can now sleep at like a 30-degree angle, now a 45-degree angle. But the entire time you wouldn't have known the difference. You interacting with him as like a colleague.

Yeah.

If you don't see him in his neck brace. That was it. So yeah, talk about like dedication to, to this research.

Yeah. But you know, I kind of want to get meta for just a second, like taking a step back. This has to be the one thing that I can never convey well enough to this other world I came from with engineers and so forth is that I do feel blessed all the time to be working with people I respect so much. And just, I just genuinely care for and have so much, you know, appreciation for how they are and what kind of people they are. Like there's, there's really no substitute for that. No, I've, I've been in teams where they could be like really hard workers. They, you know, they have their own personalities. Sorry, engineers sometimes have a reputation for not always having the best bedside manner. Um, but you know, you feel like it's a job and then you get done with it and you go home. It's really nice to be working with people that truly feel like family to me. And that without question, you feel like family to me.

No, likewise. Um, it's quite a blessing. I, you can even, I can even like, what during, was it the last day of KOSAI or the second day? I like. Left you a lovey-dovey message about just how grateful and happy I am for having met you at this point in my life, because I don't know how, uh, you know, my life would have turned out differently if it weren't for you and Adrian. I definitely wouldn't be where I am now, and I can't imagine being somewhere as fulfilling and exciting. And the opportunity, yeah, to get to work, basically just echoing what you said, with partners with complementary expertise who are just so competent and passionate, but who also feel like brothers, like genuinely feel like big brothers. I can't imagine being more grateful for that.

Yeah. Uh, you know what, let's actually take a break from the history for a sec. Cause I feel like this sets up a good segue into a topic you and I have been chatting about, especially privately a lot, but a little bit more publicly lately, which is we kind of have this, you know, Nick I had Physionic, Nick from Physionic on yesterday, and we touched on this a lot, which is this, um, the sociological challenge in this space. The thing that I keep getting, I keep wanting as an engineer to figure out how best to solve this problem is how you get more engagement with people who have differing opinions. Because to me, that's so pro-science. You've got to be open to challenge. You can't, you can't just have your strong opinion. And say, I'm really not going to accept any challenge. And I don't want to have any dialogue about it. I just know I'm right. And let's, let's be frank. There are, this is a problem with the diet space, especially because oftentimes there's this just a much more strong adherence that people feel to what their opinion is and to feel as if they've always been right. And for that matter, to push back on challenge. But that's, that's something both you and I want to try to change.

I'm going to let you start then. I mean, there's a lot of things I want to hit in this conversation. I want to do an autopsy of myself as a provocateur, because I've become quite good at that. Oreos, eggs, thumbnails, appearing on, you know, uh, certain large media platforms. Yeah.

Yeah. Well, look, look where you want to start. I'll start with this. Obviously I have a strategy. Everyone sees me doing from literally from my social media presence starting 9, 10 years ago. I certainly have a kill them with kindness effort. Like, you know, there's a, there's this great term I like, it's called a positive confrontation. So there is a catch to it though, which is that it can only take it so far. People can sort of politely decline and can basically say, well, that's nice. Or I'll get back to it at a certain point. And I won't name names, but I will say there are— in my last presentation, I was going to be a bit more forthright on particular individuals for which there are key threads that I think we were having a good conversation. But it seemed as if the evidence that I was bringing forth to them was something that they didn't have a good answer for any further. And then it just like fell off. For me personally, I feel like part of the appropriate way to work with that is to say, oh, either I don't know, or even better is I don't know, but I feel like I should get a good answer to that. And I've given that answer before, right? Where if I have a certain position, I'm having difficulty defending that position. That's usually where my strongest opinions come from is when I'm trying to defend the weaker position and I feel like the other guy just made a better case. And then sometimes that's why I adopt that case and that becomes my position thereafter. Yeah.

And I think that, that, that sounds the way you articulated, my people, most people think of it as like a concession or an admonition of weakness. I see it as the opposite. I see it as a position of strength. When you're able to say, look, hmm, you're making me think I might be shifting. Let me learn a little bit more about this. Or better yet, let's learn about this together, or maybe you can teach me. Um, and so the mark of a true expert, um, is knowing the limitations of your knowledge and the limitations of the field and being able to articulate that and delineate that for people. That's what really impresses me about someone.

But I do want to admit something, and you know this. I feel like part of being authentic is also conceding where you don't feel you're allowed to be. Right. So I want to, I want to be honest also about the things I feel like I can't talk about. So are there times in which I feel as if there's something I'd like to discuss a bit more openly? You know, I feel I have a strong opinion on it. But I also don't feel it serves my larger goals, especially if I already have one big controversy I'm working on, which is this current one with our research with lipids that I kind of don't want to open up another front. So is there a motivation, especially where I might upset people who are generally allies with me on research? That does come up from time to time. And I'll just be upfront that it does affect me, hopefully not too much. But enough to where I'll admit that.

I think it's a difficult balancing act to be authentic and transparent, which I think we both try to be, but also be diplomatic and strategic, because that's important too, right? So, you know, kind of the point you were making, or to make a similar point, there are issues about which I feel very strongly in this world about, let's say, social justice, things related to politics, you know, individual choices with respect to what people do with their bodies in healthcare. And I feel strongly about them, but I also realize that if I get on my soapbox about these things, some of which might just be opinions and ideological rather than evidence-based because of the nature of the discussion, take like, you know, pro-choice, pro-life as one example. People just, you know, will differ on that issue. I could have a very strong feeling, but to articulate it and make it an issue will alienate people and make it harder to drive forward the issue that I care most about, or that I have— I shouldn't even say care most about, I should say that I'm best equipped to tackle, right? And I think some people— well, actually, I'll wrap this in an anecdote around— I mentioned the Baking for Bears Club before. The impetus for starting it, um, was I was watching Planet Earth one day and there's this scene where David Attenborough's voice is talking about the melting of the Arctic and you have this, like this, I think it's drone footage of like zooming out on a polar bear just swimming in like this open sea of water because its home is melting. And I had a moment of realization at that point in time. I'm like, this really like cuts at my heart. Why am I not doing anything? And I realized one of the reasons I think people don't take action on issues they care about is there's so many issues you could address, like childhood hunger, um, you know, like, I don't know, HIV PrEP, or, you know, animal welfare, or metabolic health, environmental conservation. These are all important things. Space exploration. And you can't do them all. So you kind of just have to admit to yourself you can't do them all and then focus your energies on something that you are well equipped to address. And what I've chosen to do with my life is address, say, metabolic health as an issue.

We can get back to this because when it comes to food, like, you know, which by the way has an environmental impact, which would have an environmental impact, right?

But it's like, I'm not gonna pretend like other issues come up. So, you know, over the last 24 hours there's been a lot of talk about carnivore. I will tell you, I got one DM this morning asking me, you know, an article came out about me and my positions on carnivore with respect to metabolic health. I said, what do you think? I'll just say actually somebody, an account that we both respect, Earthling, who's I think generally very, you know, authentic in their questions. And I think it was a sincere question and I think it's a relevant question to ask. Now, I intentionally didn't answer the yeah, I will, because the answer I would give is like, look, this is another issue. It's an important issue. But in order to have an evolved conversation about that issue, say like environmental conservation, which is, I'll admit, totally outside my area of expertise. We do need to parse different things. And what I'm talking about is metabolic health with respect to meat intake. So let's not conflate that with greenhouse gas emissions, factory farming. Let's have that conversation too. I'm fine to have that conversation and learn from other people, but it is a separate conversation, an important one. And I think, you know, in the space we live a lot of these things get clustered, stereotyped, and then we can't have evolved conversations on a particular issue because biases just bleed into each other from one realm to the next. And it makes it so hard to have a conversation because, you know, the, the swell underneath is emotions that are coming from different angles and you need to call that out in order to have the conversation. So carnivore diet's a good case in point because it's like, You know, why was it so freaking hard for us to get, you know, IRB approval for a retrospective case series on carnivore diet for inflammatory bowel disease? These patients weren't doing any more interventions. We had the case histories. These are patients that recovered. We have good biological plausibility. Let us put the stories out there. Why the blockade? And there was, when we were trying to publish this, like, we had to go to like 6 different IRBs. I'm like, this is a retrospective case series. This is absurd. This is unprecedented. It is ridiculous.

It's worth, it's worth, by the way, setting the stage on that a little bit because whether we talk about it in this podcast or not, we are dumbfounded by the other case series or just, just case abstracts that sail through that are way flimsier and that are just instantly accepted by very high-impact journals that are telling the opposite story, or at least, you know, something that's pretty anti-low-carb or anti-keto or anti-lean mass hyperresponder.

So actually this will be fun. We'll draw a contrast between the recent carnivore report in JAMA Cardiology and our case report and what comments we got in review. So I'll, I'll just actually go to the, the JAMA Cardio case report quickly 'cause it'll be easy to cover. I did a, a 6-minute breakdown of this on my YouTube channel, which you can check out where I really rip into it. There was this recent, case report in JAMA Cardiology, which is a highly respected journal, saying that an individual went on a carnivore diet and developed xanthelasma. So there's these pictures of him, quote, oozing cholesterol. Those are the headlines out of his skin. Now, the case in question, they described the patient only as a man in his forties, no other medical history, no genetic history, family history, or any other pertinent information, which is already very weird. You don't describe a patient as just a man in his forties when they have this profound a phenotype. They then go on to suggest that he was eating 6 to 9 pounds of cheese, butter, and beef daily. 6 to 9 pounds of cheese, butter, and beef daily. This is implausible. And it's written a little bit vaguely, which people have pointed out. But you can actually see an interview of the first author on Fox News doubling down on, yes, it was 6 to 9 pounds daily. As articulated verbally by the first author. Again, this is implausible. This is not a case report. This is a mocky Python skit. And they also don't, like, provide any sort of verification. So I've reached out to the journal to see if they want to provide any defense. I've reached out to the first author via email, politely including CCing you and saying, look, this really seems unlikely. Do you have any more data on this patient that could be shared publicly? Do you have any verification that he was actually eating this or what else he might be eating? Because it seems a little bit implausible. And in fact, if you want to get genetic testing and just write a more comprehensive report, I will support you in doing this and I'll do it at my own expense. I will pay for his genetic testing. We haven't gotten a response.

So anyway, and really pause for a moment. The first author was on Fox News.

Yes.

Fox News from, and you had a slide on this from yesterday or day before yesterday at COSI saying this is the whole report because it was 150 words.

Yes.

Right. So think about this from, from a return on investment standpoint for a researcher. Yeah.

Not a researcher. He's a clinician. I don't think he has any research background.

Even better. You get, you get something you wrote published in a high impact journal. You get interviews from syndication, from mainstream media for something that you, you know, for the level of effort that's put in, seems like a really good return. And it's kind of an advertisement for other people that this is a great place to spend your attack strength on.

When I say this report probably took 4 minutes to write, I kid you not. You can look at my YouTube video. I'll show the whole report. I could have written this report, taken the photos for it, captioned it in 4 minutes. It was 4 minutes worth of effort for someone, actually probably less.

So now let's take it back to the Case Series. The Case Series was a, a series of folks who were on the carnivore diet, right?

We had, uh, 10 patients on the carnivore diet. We had, um, medical histories. We did comprehensive interviews with each patient. We had colonoscopy reports, we had lab work, we had prospective dietary journals that people kept with gram measurements and photos. And we had patient direct quotes and of course, all the consent and appropriate approvals now and dietary records breaking down like, like percent saturated fat content macros. We had a validated IBD-Q32 questionnaire to look at how their symptoms changed. And again, in addition to lab reports and like colonoscopy reports from their doctors, we had all that for 10 patients. And during the review process, even after like getting this giant headache of getting like our 6th IRB or going to the 6th IRB, the reviewer's comments were things like, did you control for water intake? How many, how many ounces of water was each consuming per day? And that might have been a confounder. I'm like, is this a— I remember doing the review. I'm like, you have to be polite to your reviewers, but I'm like, uh, please explain the biological plausibility for why a difference between like 32 ounces and 40 ounces of water would affect whether or not they go into clinical remission from IBD. And I'm like, we can write this as a limitation, limitation section if we want. We did not control for H2O intake, but like, You joking? Like, we have like comprehensive dietary tables, food logs that are prospective. So this isn't like, oh, what'd you eat last week? It's like, no, take a photo of the thing you ate, weigh it on a gram scale for us, and keep a prospective dietary log, cuz I wanna know what you're eating.

And, and, and again, uh, just so it doesn't get lost, cuz I really think it's worth emphasizing, you're right now talking about the publishing process with the reviewers. When you were telling me you were on your 6th IRB for a retrospective case series. It's absurd. That's unheard of. I've never heard of it. Okay. So an IRB approval for like a major clinical trial, that could be understandable why it would take a while, but even if it takes a while, it's almost never like outright rejected. But for a case series, those are, they sail through IRB because it's It's already done.

Oh, it should have been an exemption. They should have been like, this isn't human trial research. Yeah, go ahead. So like for my Oreo versus statin study, right? Harvard's just like, this, this doesn't qualify as human trial research. You're doing an n 1 on yourself. Go ahead, do it. Right.

Whatever.

So that should have been this, but because it was, I mean, I'm, I'm assuming it's because it was carnivore. I really don't think if it was any other dietary approach, I would, we would have hit these obstacles. This is completely unprecedented. When Adrian's on, you can ask him his two cents as well. But let me say this is not the first or last unprecedented thing that has happened in the publication process when we're trying to publish controversial research. We had an interaction where we had our meta-analysis, 41 randomized controlled trials at a top journal that had positive reviews, and the editor just started ghosting us. Totally unprecedented. Why? It's not like the data aren't robust. It's like, hmm.

Even our senior author was blown away cuz he had never experienced anything like that before. But it's, you know, th—

this is a— do you wanna just complete the, like, buffet of absurdity of the Circulation report?

Go for it. Oh yeah, sure. Please bring that baby back.

So this was a report in the journal Circulation, one of the highest impact factor cardiovascular journals.

No spoilers though. Just only comment on the thing that you, you know, about the In other words, okay, don't bring up the comparator. Oh, you know what I mean?

Okay. Yeah. So the, yeah, the report was something to the effect, we, you can even Google it and look up the title of the report, but it was something to the effect of, I want to get, I actually want to get a word for word. Do you wanna Google it real quick?

It was like, yeah, I'll Google it. Go ahead. Yeah.

So it was in Circulation abstract that was presented at the American Heart Association conference. May I say they just, they did reject or decline to bring up other lean mass hyper-responder related content at this conference. I'll leave it at that broadly. Is that fair to say? Hyper circulation.

Circulation.

Yeah. All right. So yes, this was it. So we're gonna, we're gonna November 6th, 2023. Abstract 17807. Rapid progression of coronary artery disease after stopping a statin and starting a ketogenic diet in a phenotypically lean mass hyperresponder. That's the title. Right. It's a title with the— Let's dissect what the claims are here on the title. Right. You want to do it for the audience?

Yes.

So there's a couple claims. One, what? What is a phenotypic?

Uh, it's a lean mass hyperresponder. They call it out directly.

And then what happened to this lean mass hyperresponder?

There was not just progression of CAD, but rapid progression of coronary artery disease after, after stopping a statin and starting a ketogenic diet.

So there are strong claims in this title. Okay, let's first say he wasn't a lean mass hyperresponder. That, that, that actually is a funny, like, it's funny to say, but like, that's a point I really care less about. They didn't mislabel his phenotype. I'll, I'll give them that. For whatever reason. Maybe he was trendingly mess hyperresponder. He was. So let's even give them that. They probably should have been more accurate in the title. But that aside, in order to claim rapid progression of coronary artery disease after stopping the statin and starting a ketogenic diet, you actually need data saying, okay, this person stopped a statin and then while on a ketogenic diet, their plaque progressed. That is not in this report in any way, shape, or form. The actual report is that a guy at some time in his 40s had an intervention, a PCI percutaneous intervention, because he had stenosis, blockage of his left anterior descending artery, a major vessel in his heart. So they basically had to go in because he already had a blocked vessel. Bear in mind, this is when he was on a mixed diet. He had never tried keto at this point. And while they were there in his heart, As you kind of like presumably open up this ventricle, they didn't say they were stenting it, but I assumed they were stenting it. They saw, oh, there's this other ventricle, the right coronary artery, which is already has mild disease or moderate disease, I should say. And they think they characterized it as moderate disease. Okay, well, we're gonna give him a statin for secondary prevention and let him off into the world. Again, guy with existing heart disease being treated with the statin for multiple years and a strong family history of cardiovascular disease. Then at some point in time he tries a ketogenic diet and at some point in time thereafter he has a right coronary artery occlusion.

Wasn't there, wasn't there in the report some description that we could ascertain there was at least 2 years where he had not yet started a ketogenic diet?

He was on a statin for 2 years, right? So, so we do know he was on a statin for multiple years after he was treated for a prior vessel block and already had disease in this other vessel. Right. And during that time they did no further monitoring. Right.

The, the title is obviously trying to imply that this lean mass hyperresponder stopped a statin, became a lean mass hyperresponder, and then developed a rapid progression of plaque as a result of that.

Right. So, but, but they don't say how long he's on the ketogenic diet. So it's a very plausible timeline that he had disease. They went in to address that disease in one artery. They saw moderate disease in another artery. 2 years then he was on a statin and then maybe he ate bacon for a week. It didn't say what his ketogenic diet was or how long it was on it. And then he had more disease in the other artery. You're really gonna pin that on a quote ketogenic diet. There were multiple levels of lies in this report. And then it gets published in one of the highest impact factor cardiovascular journals.

And it's not just that, it gets presented at, at one of the top big three cardiology journals. In fact, arguably the top one. AHA Scientific Sessions is considered like the place where you, yeah. Bill Cromwell says it's the one you take your date to, that that's like the top place to go.

Yeah.

So lots of accolades for that team.

And then it, yep. For sure. It definitely made the rounds and I tried to do all the right things to respond, including writing the letter to the editor with cardiologists. And after it was composed, we realized because of the nature of the fact that it's an abstract and they're not gonna write a full report, you can't even write a letter response or an e-letter, which is available for other forms. So there was no formal way to, as a professional in that professional setting, actually respond academically. I did post the composed letter down to Twitter. But that's all we could do. All we could do was call it out on social media because there weren't pipelines to write a response in the literature, even though I think I can characterize this fairly as multiple lies that should not have been published in circulation. And I've called the JAMA Cardiology, and I will call this case reports embarrassments and shames on the intellectual integrity of those journals. That absolutely should be retracted without a question. And I'm not timid about putting that forth even as a medical student. Bear in mind, some people could, you know, come out to get me because it's so clear-cut. Yes, I'm using strong language, but it's very easy to back this up. This is absurd and should not be published. And it is not a cautionary tale that is helping out people because it's providing a clinical conservative stance. Well, I can—

I can I can verify right now that there are now 3 different people who've DM'd me or have posted, who have DM'd me or posted in the LMHR Facebook group where their doctor had provided that to them.

Right.

So the doctor of course looks up lean mass hyperresponder. Oh, did you, did you know that this is where you're probably heading next?

And, and, and what happens then? Mistrust. And understandably so, because when propaganda bullshit like this gets published and you are a lean mass hyper-responder who wants answers and feel like you're being brushed under the rug and set aside with publications, heavy air quotes on that, like this, and then somebody throws that in your face, you're gonna be pissed off. That's totally understandable. So waving these around, these aren't cautionary flags that are helping anybody. They're just creating mistrust and actually in and of themselves a danger because they're going to steer people away from, you know, collaborating with their doctor and conventional medicine to get answers that are right for them. And I firmly believe that. In fact, it's quite comical to see what people say about me given some of the stunts I've pulled, like the Oreo versus statin thing, where it's like, you're persuading people that Oreos are a health food. Now they're going to go binge Oreos and get a heart attack. I'm like, Really? Seriously? Like, if I pull a stunt, it's obvious enough, like, what my claims are, and I usually caveat things pretty carefully, but like, nobody's gonna— I don't think anybody's realistically gonna believe Oreos are a health food. You know, you can do metabolic demonstrations, and I think there's a way to artfully use engagement tactics, but when it bleeds into academic publications like this, in this sneaky double standard way in academia, it just breaks down the integrity of science and medicine. And that's a huge, huge problem.

Well, and there's, there's an important distinction that needs to really be drawn here. That's asymmetrical. On our end, we're, we, we're trying to induce the conversation. We want the conversation, bring the conver— engage us, talk to us. We, we want to discuss all of the research we've already published, and we put our data out and we put our code out on day one. Every— everything so far that we've been able to put out, we've been able to put out the data and the code right away. Granted, we have to negotiate internally with the teams, but thus far that's every single thing we've had our names on, right? Conversely, you can't get through to either of these first authors for these abstracts. They won't apply, but they can still get the benefit of being highly celebrated, not only in high-impact factor journals, but also to either, you know, present at the AHA scientific sessions or appear on Fox News and just eschew any direct challenge to what's being put forth as their case. That's— and this is the thing that I think you're coming to that, that I really appreciate. Which is you're saying you're, you're turning back to the medical establishment and especially to science and you're saying, listen, I'm on your side. I want you to have credibility. I'm trying to tell you how you lose it. This is how you lose it. Yeah. So don't complain with low-carbers are losing trust in you when you have these kinds of things going on. Yeah. Right. Like, here's how, here's how you regain the credibility because I'm on your side. I want you to, I want you to get it back.

Yes, so don't— precisely. Um, to your point about like open science, it's actually kind of funny how people respond. I think they're surprised by how open our science was. Um, you don't like to name names, but I don't mind. So for example, like in our group message with Layne Norton, when he was asking at the time, I thought sincerely, I don't think it's sincere anymore in retrospect, but out of our meta-analysis of randomized control trials in the DM message, and he was asking some, I think what he thought were hard questions. And Adrian's just there like typing away like, oh sure. Here's all the code, open access. Here's my digestion of it, but please go play with it as much as you want. Come back with other perspectives. We would love to hear it. And I just remember him like seeing me like, oh, hmm. Pause. He never ended up commenting on those data.

I'm still— You're right.

By the way, Lane, if you're listening, you are very welcome to come to the table, good sir.

Yeah, no, listen, I, I would love to have him here. I've. I've invited him to both COSIs. I'll invite him to the third one if, you know, if we have another one next year. Yeah. I would, I would love to have them on a panel. I would love for a lot of these bigger voices in the nutrition space, but I, I think it is fair and I'm doing it with you. I think it's fair when there's specifically addressing our research. At that point, you should absolutely be open to having the conversation with us, especially if we have qualms with how it's getting represented.

Yeah.

And in the case of the meta-analysis, I was disappointed because that's how the conversation started. Why didn't it get covered? It should have gotten covered.

So, so, so people who know us know we have a good cop bad cop going, uh, scheme going with Dave's good cop, big teddy bear, and I have edge to me. I will be clear though, with respect to like internet beefs, I am very deliberate and have rules around the degree to which I engage with or amplify conflicts. These include that it has to be functional, not just for clicks or engagement, but because I'm correcting the matter on an important record with respect to data, or calling something out like very inappropriate bullying-type behavior that I don't tolerate. Um, so that's rule 1. Rule 2 is that I must have had to try to build an alliance or a bridge. This is usually done behind the scenes. In this case, I very much tried on multiple levels to do so with the named individual in question. And 3, I always retain the right to turn a functional foe into a functional friend. I have a whole video where I'm like laying out these rules and saying like, look, hold me to these rules. I'm not just here, I don't go seeking drama, but I don't mind it either., and I don't mind leaning into it if I think it's the right thing to do. So in this particular case, yes, for someone who pretends to be about data over feelings, who pretends to want to cite the randomized controlled trials, when you misrepresent the physiology, which we've explained to you, brush the randomized controlled trial under the rug, and then engage in bullying tactics when you get questioned by well-meaning people, I will call your bullshit out.

Well, it's, it's, it's, and I'll capitalize on that to just to be very frank, part of why I was disappointed was he was and he moved toward the Oreo versus statin experiment and highlighted that it's just an N of 1. And that's part of why I was so frustrated is if it, it started in the best place, which is the meta-analysis, which is not just an N of 1, it's a meta-analysis of 41 RCTs of low-carb naive populations. It was the best data. That's so the opposite of an N of 1.

Well, it wasn't, what do you mean low carb naive? They were low carb. No, no, no.

As in, as in these were arms of intervention toward people who are not already low carb.

I don't know if it was in the inclusion exclusion criteria because, you know, now people are going to go nitpicking on our word choice. Let's just say possibly it was a 40, it was a very comprehensive, elegantly done, robust, you know, meta-analysis of 41 randomized controlled trials that he chose not to address. You can speculate as to why.

Let me put it, let me put it this way. If anyone wants to place a wager with me, I'll give them even money that at least the, I don't know, let's, let's say I can safely bet that 75% of the individuals in those meta-analyses that were in the low-carb arms had not been on a low-carb diet before. And that's why it's relevant.

How much do you wanna bet? Because I have a, you do, I have a punchy point for you, but, oh, by the way that I phrased it. Okay.

All right. I'll, I'll bet you a, a crisp blueberry applebee. Yeah. No, you, you already gave up yours. No, I, I'm kidding. I was going to give you another one. Yeah.

So I was eyeing that. So, so here's my punchy retort. How are you going to define low carb, Dave? Ah, you know, we're all over that.

Yes. Yes. You know what? We should, we should actually jump into that too.

Oh, I'm, I'm, I'm seeing you up to it.

Oh my God. Because even, but I think I'll bet you my thread predates you getting into social media. Because I kept trying to stay away from other controversies while sticking to lipids. And I want to say it was in 2018, 2019, but it's as Nina Teicholz was getting into, um, trying to campaign for the dietary guidelines. I think it was for the 2020 guidelines. Anyway, sorry. Here's to set the stage. I'm trying to focus just on lipids. I'm trying to emphasize that I'm not just a low-carb only proponent and, you know, participate too much in the diet debates. I still try not to, mainly because I don't want to be, I don't want to be associated that I'm just into the lipid research so as to specifically promote keto because I don't think it's a panacea. I think it's just that there's a lot of research that backs it up for certain people and for certain circumstances. Anyway, unfortunately, getting back to the deception factor. More and more studies that seem to want to classify low carb or even keto. I love this new term, keto-like, are way off base from anything the community or any major voice in the community would actually consider to be low carb. Yeah. They often classify it to 30% to as much as 40 or 45%. I even know one person who was saying is 50% or less. You could basically just take any study of 50% of calories from carbohydrates or less is good enough to be low carb. And I just, I made a big long thread that just called out all these different things, ice cream, pizza, donuts, all sorts of things that were that percentage of calories from carbs or less.

Right.

Because that's just, I, there's gotta be some threshold with which you've gotta have some intellectual honesty with engagement of a community. And by the same token, I think if I did a study on the vegan diet and the intervention was Skittles, which are technically vegan, we're gonna talk about urine equals one later. Yes. It would be, it would be intellectually dishonest to say that that's that, that's comparable to what vegans would consider a healthy vegan diet.

Right. So now I'm going to apologize for going back on the Layne train for a second. And I just want to be clear. One of the reasons I have two reasons for leaning into Layne, and it's not because I'm actually salty. Like I, people who know me know, like I'm, I'm pretty deliberate about where I release my emotions, but he's such an incredible, great case study in Well, one, bullshittery, but two, in what, what I would characterize as a co-evolution for clicks between standard media like the JAMA Cardiology report and the Circulation report, and then influencer engagement bait where they feed each other in this positive feedback cycle, which degrades intellectual integrity. So Lane, because he knew it would get him clicks, did a thread on the carnivore diet. Saying he's diet agnostic, but also this is why you shouldn't do a carnivore diet. And the studies he chooses to cite are those that are quote, a meta-analysis and then a Cochrane review with 40 and 45% kilocalories from carbs as thresholds. Now, you know, to do a backhand calculation, if you want to get a sense of what that actually means, you could be on a 2,000 calorie diet, eat a brownie batter donut, apple cider donut, and chocolate frosted donut, and 6 munchkins from Dunkin' Donuts every single day. And I calculated that, that's 189 grams of net carbs. So even on a 2,000 calorie diet, which is on the lower end of things, you could eat all those donuts and still be carnivore if they, I guess, were animal-based donuts and you're eating only meat otherwise. Like, bottom line, like, that is a gross misrepresentation. But for those who aren't going to actually do the digging onto the PubMed ID that he put and then like click it into, you know, put into PubMed and look at like what the criteria were. It sounds authoritative because it was like, in the meta-analysis say, you know, and it's a good tactic. I call it citation volume where you just throw a bunch of references. A lot of people do this. You'll note where they're trying to make a claim, but they won't really actually like care about what the reference actually says. They just want to make a point. That thread by him has over 5— I mean, within a few days, I think it had over half a million views. It was great engagement. So yeah, I'll call that out. Now, because I think it's BS and I like to crush BS.

I'll, I'll, I'll be devil's advocate back to you.

Yeah.

For a second. There's kind of another way to classify carnivore diet, which if it's animal-based, then that might, for example, include honey. Okay. So in theory, in theory, you could be downing a whole bunch of honey and actually get up to 40% of calories from carbohydrates. All right.

Well, will these studies done on the Paul Saladinos of the world? No, it's true. I mean, a lot of this comes down to semantics, but in terms of the idea is you're trying to generalize from a given study or set of studies to another population. So if were classically practiced at a carnivore diet was to include 200 grams of carbohydrates from honey daily, then I wouldn't have qualms. The fact of the matter is I don't know many people on carnivore diets who are even eating more than honestly 10 grams per day, let alone 200.

I just feel like there is such a thing as community standards. I think if, I think if a diet has a particular title, yeah. And the community at large is coming together on what that means. Again, I, I hate to put it this way, but there's an intellectual honesty index, if you will, as to how much you're trying to study it.

Right.

And if you're, if you're trying to co-opt that label, And then you're throwing it against something that the community would never consider. It's, that's my problem with it.

Well, also then if you like, if you have a point to make, you should be able to stand up and defend it if somebody's making a big enough noise. So in this particular case, yes, I did a response video to Lane, has well over 300,000 views. He's quiet as a church mouse. Why? Because I don't think he has quite honestly the cojones to stand up and defend his point of view. Not because it doesn't bother him. I have pretty good intel that it does bother him. But because he realizes he has no legs to stand on. And so now put yourself in my shoes for a second about how I should deal with this. Because I've gotten advice from people, uh, let's say in this space, people I really respect, which, you know, some people say like, just avoid the drama, focus on your content, move forward. Don't worry about what other people are saying. I kind of get it, but And now being fully transparent and candid here, one, I do want to correct the record where I think it needs to be corrected, where he's not willing to own his own mistakes on this or other problems. So I think it's relevant, but I have messages to get out there, including say about our meta-analysis of RCTs, which we just wrapped into this discussion because I want people to read that. It's an incredible paper. Hat tip to Adrian. So if I want to create a hullabaloo and start conversations around things that are important to me. I'm gonna use what handholds are available to me. And yes, responding to Lane Norton is one of them. So there is an element to which I benefit to responding and calling out his bullshit. But I will be very clear, like, the calculus here is that if he's putting stuff out, stuff that I can respond to, and I can respond well, and I'm definitely not scared of him, then I win, he loses. Win-lose. However, I genuinely think I would have a lot more to gain were he to reconcile with me, bury the hatchet, sing kumbaya, hukuna matata.

I think he might have a lot more to gain too.

So what I was going to say is right now we're in a win-lose situation. He's losing, I'm winning as far as I see it. I don't think anybody who's following this back and forth, this beef, whatever you want to call it, would see it any other way.

Um, let's say I'm, I'm trying to do my best to be Switzerland, which, you know, I try to do.

I'm laying out, but, but, but yes, let me get just to my core point, which is my goal. Like, just think about like Nick Norwitz wanting to quote win, but I don't care about the degree to which other people lose or win. It's not really part of my calculus, and at least not to the same extent. So I think I'd win more. If it were a win-win situation, if you think about it, like, you know, there's a zero point, right? Right now I'm at a +5. He's at a -5. I think if we collaborated, he could be at a +5, not a -5, and I could be at a +10. I don't care about the delta between us. I only care about the plus that I have. So, you know, he's, as far as I see it, forcing my hand. And he could get something positive out of it if he was willing to bury his ego. I don't think he's willing to.

So, so I'll do my best Switzerland here because, you know, I like to. Yeah. But it's— there is, there is a component that I do have to defend you on here with regard to— if left unchallenged, there's no question that there's people beyond you and him. There are people being influenced by what each of you are saying. So I know there are a lot of people who appreciate when something's being said that they would object to whether or not it's evidence-based, for which somebody is coming in and saying, I got the receipts on the evidence.

Yeah.

Let me lay this out. Right. Just, just today I retweeted your New York Post article and you were discussing that and there were, there was some challenges that I wanted to jump into the discussion myself and kind of expand on that as well. And it's good that it's finally getting discussed and there's more engagement, there's more back and forth that's happening. To really get these things into the front end.

Yeah.

So I think this is the benefit of social media is even if there isn't a direct dialogue going on between you, there is at least the dialogue that takes place over social media that you're signaling overtly, hey, I wouldn't mind if this got closer. I wouldn't mind if we actually had this discussion. One of the things I want to do with this podcast and may ultimately have some in this first tranche. Episodes we'll see is I want to have more live debates. I want to have more people sitting down physically in the same space having these discussions.

Yeah. It would be an interesting one between me and Lane. He might end up punching me. We'll find out. But I think, I think there is something to like, you know, holding people to an intellectual standard. Like you cannot get away with bullshit. You can call yourself a BS crusher, but it like, what do you do when you have your BS crushed? And Yeah, I, I don't mind walking the walk with respect to that and putting it all out there. He wants to step up and we can have a discussion. But also, and this is now more a personal note, the straw that broke the camel's back for my first response video, which I literally did like on a cell phone in between patients at the hospital, I think I titled it like, you know, Layne Norton gets a D in lipid energy, was not necessarily him overlooking our meta RCTs or screwing up on physiology that we explained to him in DM multiple times, it was the bullying. Even people who like Lane needs to know he is a grotesque bully at some point in time. That's not an ad hom attack. That can be like very clearly characterized where he's saying, I have a PhD in nutrition. You're just a fucking eye doctor, Eric, sit down. I have no tolerance for that. I've never had tolerance for bullies. So when I see that kind of behavior, that's what makes me stand up and call it out, especially when you are being questioned on legitimate matters of research, data, and science, and you don't have the arsenal to respond intellectually, so you virtue signal, credential flex, and put down others using the size of your platform. That is incredibly— well, I don't tolerate it, and I will call that out as inappropriate behavior. So there we go. All right. I'll zip the, zip the, the line comment, but I genuinely think he is a good case study in social media because love him or hate him, he's incredibly successful as a brand builder and, uh, you know, person in social media. He has a giant brand. I'm sure he's very successful in business. I'd be surprised if he was not a multimillionaire. Like he has monetized himself and built a brand and business around himself and the perception of rigorous science that is incredibly effective. And so it's important to use that as a case study and analyze the incentive structures that he has and question whether he's being intellectually rigorous and trying to put forth nuance, which I would think if he's trying to platform nuance, he'd actually have a conversation with you, me, Adrian, or Will Cromwell, which we offered. Or if he's just trying to build his own brand more. Which is more consistent with his behavior to date. Again, I'm only putting this out there in this format with him not present because he's had every opportunity to represent his point of view and have this dialogue. And if he genuinely feels he's doing something with a high degree of intellectual integrity, I don't see why he wouldn't step up for the conversation. Because this is gonna happen, this conversation, with or without him. I'd like it to be with him. That's his choice.

Let's move into lean mass hyperresponders and risk.

Oh yeah.

At a population level.

Wait, are we gonna hit on recent carnivore discussions before we do that?

Recent carnivore discuss—

oh, the New York Post Fox thing. Oh yeah. Awesome.

If you wanna expand on it, go ahead.

Yeah, because you, you brought that. So this is just another general, like, you know, um, example that where there's a lot of bias against something without a lot of rigor. And discussion around it, we were talking in general about JAMA Cardiology, um, circulation, but also how they get covered by the media. There's a lot of fearmongering around carnivore. It's a sexy thing to do both on Twitter by influencers and by academia, and it makes it really difficult to have conversations about things like a carnivore diet, which I think are incredibly promising. As a metabolic health intervention that deserve further study. Yeah.

So, so it to, to help reset you. Yeah. I think I may have missed, I guess there was some article attacking the carnivore diet. This is what you're referring to. That's recent. Is that what happened?

Just the general theme of, I mean, we had the xanthelasma report in JAMA Cardiology. We have Lane going after and attacking it. And you just know as a pattern in general, how many times do you go on?

Oh yeah.

Like social media and just see how somebody's like, the carnivore diet's an eating disorder. It's stupid. Look at all these carnivore idiots. Like just out of the blue comments attacking the carnivore diet.

Yeah.

Well, it just, it is now built into culture and it's incentivized. That's the point. It gets great engagement.

I think it's because it's so controversial because of course it sounds, I mean, it sounded when the first time I heard it from Amber O'Hearn, it sounded so extreme. It sounded so outrageous to just be only eating meat. Right. And to be fair, a lot of carnivores will say there's multiple flavors of carnivore. For example, a lot don't have just meat, but do have one form of plants, which is in the form of coffee. Some, as I mentioned, will say that honey is allowed cuz it's an animal-based product, et cetera. But I, I think generally the community standard is it's a 95% or more meat-based diet. I think, sure, would be kind of considered carnivore. But yes, it's enough in the zeitgeist, it's known enough that naturally people are at least talking about, even if they're not on it. And you're right, there's, there's just a broad base attack against it at the same time.

So long story short, the, well, actually no, long story long, we're gonna be going here for like 5 hours. It's not being long story, I don't know why I'm saying long story short, but yesterday an article came out on Fox News and the New York Post covering a video I did. In fact, I posted the the full video, um, Busting 8 Carnivore Myths. And I find myself in this funny position on a couple fronts. Um, one, I don't fancy myself like a carnivore defender, like per se. I'm not like, carnivore is the best way to live. I actually think that there might be certain drawbacks, but to like actually deconstruct some of the myths going on around the carnivore diet and how there are these double standards attacking even just red meat intake. Um, like I did a rebuttal to a recent report in the Journal of Neurology saying red meat was bad for the brain. And it's like, it doesn't show that at all. There's huge healthy user bias. And you know, even in the discussion section where they're trying to talk about like, oh, why might red meat be bad for the brain? They're saying like, oh well, saturated fat decreases brain-derived neurotrophic factor. But you look at the reference and it's like, well, the saturated fat diet you're referring to is actually a mouse diet. It's called an HFS diet, which stands for high-fat sucrose. Diet. So like, no, there's not a legitimate argument made here. Now, love or hate meat, issues with the environment or not issues with the environment, like the matter at hand here is do we have a case to make that this might be helpful or harmful for different use cases? And in my estimation, there's incredible reason to believe that a, a carnivore diet, including like a lion diet, like even just meat and salt, could be tremendously beneficial for patients with autoimmune and inflammatory conditions.. And, you know, I go through 8, you know, total myths, but my focus and my motivation is to be like, let's be scientists here and be curious. I'm not claiming there are RCTs on a carnivore diet yet, or that there's rigorous data that should make it standard of care. I am not claiming that. I'm saying there's great biological plausibility and a mountain of clinical narratives of patients having, quite honestly, incredible mind-blowing results that should make any clinician curious. When a patient goes into remission from schizophrenia or severe inflammatory bowel disease, that's been plaguing them for 20 years. They've had multiple surgeries. They've been on multiple biologics, not helping. Then they change their diet and they go into full biopsy-proven remission. How are you not curious about that? How do you not want to further that line of research? And, and here's the crux of the matter. That does not imply that I'm making a claim about climate change, environmental welfare, animal-based diets for longevity, or any of that.

Or, or even that this can apply to most people. Like, I think this is another thing we're both very careful of.

Yeah.

We'll acknowledge anecdotes for being anecdotes, but if there is an anecdote of somebody fill in the blank diet, going on X diet, and all of a sudden they're, they're resolving bipolar disorder, symptoms. They're, they're dealing with their schizoaffective disorders, right? These, these are real stories that are out there. And a lot of folks are either on extremely low-carb diets or on carnivore diets that are sharing this. That should at least spark interest, right? That's like a no-brainer's no-brainer.

You go like, so, right. You think so. But people, I think the issue is these is the underlying issues bleed into each other. So you get stereotype, especially, let's be honest, if I appear on Fox News, people are gonna assume assume things about me, things about my beliefs in environmental welfare, climate change, probably even my politics. And I'll just say, probably shouldn't assume my politics based on me presenting on these news platforms. And quite honestly, I've thought a lot about the host. I've been on podcasts with people, you know, that aren't— I'm not necessarily fans of their work. And I've been profiled and covered by media outlets with my permission, where I don't necessarily agree with their broader, you know, political ideals. But my thing is like, I have a message to get out, right? It's about a very particular topic. So as long as it's not being politicalized in the article per se, I actually do want to create pressure for this being covered by multiple media sources. I tagged today CNN and Fox News together. About, like, say, the xanthelasma report. I'm like, the next thing is to call out this Cheney report for what it is— propaganda. I don't care who does it. I don't care if the reporter who writes the article voted for Kamala or Trump. That is immaterial to me. I realize it might not be immaterial to other people. I think of this as, you know, a topic for open discussion.

But, but there's, there's a component here that I think is worth drilling into, which is that I think that you would, you would love for it to just be the way by which you could get the message out is apolitical in its delivery mechanism. I, I would like that too. Right. And a lot of the, the thing that, if you don't mind my sharing, but I think you'd be fine with me sharing it, is that you have, certainly this is the case with me. I have family from both sides of the aisle and if I show up on a certain host's show who is on one side of the aisle much more than the other, then those family members on that other end of the aisle can sometimes feel like that's me staking some ground, right, in a particular position that they're going to take a bit more personally. And I think a lot of people don't realize that that's a challenge in being a public figure. And being a public figure, a lot of it is you're just trying to move the cause forward, especially if it's regarding research. And you're trying to do it every way that you can.

Yeah. I mean, I'll just say, you know, I don't really care for limitations on TMI. Like the first time Fox News covered me, my partner, my girlfriend was getting texts from her friends with commentaries about my presumed politics. Did you know your boyfriend XYZ XYZ? Like, does he XYZ XYZ? And I'm like, it, it kind of feels shitty. I'm not gonna stop, but like, look, can we just parse these issues as different? We, we, I, I was just talking about Baking for Bears and like what I cared about as a teenager, which I still care about, environmental welfare. Like, we can have that discussion too, but that is separate from me saying, look, I've met people with debilitating conditions who have had their lives saved with a carnivore diet. Can we explore this as a scientific community without having those patients be shamed for their dietary choices and having it be called an eating disorder that hurts people? And so I want to push forward scientific curiosity around this as a metabolic intervention. We can also have evolved discussions about related topics. In fact, kudos to you at Coscii. We had Chris McCaskill.

Yeah.

Well, and Chompers, a friend of ours, to talk just on that issue. I loved the presentation. I don't know if everybody in the audience— he was definitely speaking to like an audience that was biased against him, but he had the balls to show up and present his point of view.

And we had a debate between him and Peter Ballasted that I thought was a great debate, and it was, it was specifically on animal agriculture and environmental sustainability, right?

And both of those people were okay. They might not like each other, especially after the debate. They might not feel like moved around, but they were both willing to to show up, to travel to Vegas, to show up and have that debate publicly and put their ideas out there. Especially Chris, um, who was speaking to an audience who, you know, has bias to be against him. And I think he did a pretty artful job calling that out in his presentation.

I think, I think it had a leaning, but I'll, I'll say this in Chris's defense. I had heard from Tom Bartlett, who's, who was calling the show backstage, that some people had mentioned that His was their favorite talk at Cosei.

That's right.

Yeah. That's again, to me, to me, this is all the better. I'd love for Cosei to eventually be a place where just a wide spectrum of voices, like it would be the place that everyone knows they can come together and just hear a wide variety of cases for everything.

And a lot of fruitfulness comes out of being willing to meet people halfway, right? Or in the middle. Like it was really incredible for me. Um, Chris hosted a conversation with me and Walter Willett in Walter Willett's house. Like to have that conversation is a great privilege to me because I get to exchange ideas that I'm dealing with and present them to someone who does get stereotyped and typecast, say like within our community. And it's pretty interesting when you, you know, go behind the door what they're willing to say. So like in our one interview, you know, I'm interviewing Walter Willett, probably the most cited person in nutrition research alive. Probably. I know a lot of people listening may not be fans of him, but like, you know, he's a highly respected person in his field. And you know, we talked about things like Kevin Hall's, 2021 Nature Medicine study. Now that was a study that ultimately concluded low-fat plant-based diets are better than low-carb diets for weight loss. So you might think that Walter Willett being a plant-based guy might defend that point of view. He called Professor Hall's research— what was the phrase— worse than useless, but worse than useless and misleading. You can watch the video, we have that on camera. Yes, I'm being pokey, but like, with purpose. Again, taking a meta step back here, it's like, yeah, let's have this conversation among all of us. And it does take a little bit of provocation, but provided you can back your legit bait, or let's just call it clickbait because there's different flavors of clickbait. If you can back it with strong science and arguments, then I think it's fair game. That's why I did things like Oreo versus statin. Of course it's clickbait. That's the point. It's engagement bait, but it's engagement bait that I can back with a trial with pretty rigorous data as far as n=1 goes. And then double-digit numbers of papers, including our meta-analysis of randomized control trials, which everybody's sure you did, right? So there's— it's, it's the strategy here.

Yeah, it's, you know, I, uh, I, I want to bring it back to this larger arc that on some level we're still human and we're still reacting to the anticipation of how things change these relationships in our lives with our family and our friends, with who we're connecting with, who we're not, in order to get this science out there, in order to get the word of this out there. Right. And this is a place where it does frustrate me sometimes that politics does find its way, especially, you know, left and right into nutrition of all places. It's, it's a, it's frustrating to me, but by the same token, I'm feeling more optimistic than I did before that a lot of that may be changing. I feel as if, and I don't know, maybe I'm still on the high from KOSAI and chatting it up with Chris, maybe, you know, like with Walter Willett, you chatting it up with him as well.

I don't know.

I, I have a sense that there's going to be more productive conversations. Coming into this year compared to the year before and possibly last year compared to the year before that.

I agree. But the question I put to you is, do you think that is a function of changes in the media landscape or just a function of our profiles? No, I think as indiv—

like you and me as individuals, if I'm being straight up, I do think that there's a disruption in the media landscape.

Okay.

That's so there, there is certainly, there certainly was Um, this is my, this is my optimistic take. My optimistic take is that if you go back to my old days, there was kind of a creed with journalism to be as objective as possible, or at least to present as objectively as possible. I know that there would be a lot of arguments, um, and cases to be made that there was still a bent. Right. I feel like, and I think a lot of people would agree with me, that in the last half decade to decade, there's been a level of polarization across all forms of media like I've never seen before. Right. And to a degree with which there's a lack of conversation with each other. And while I think that there's still plenty of polarization, there's still plenty of yelling, screaming, et cetera. At least in the space of nutrition, it feels to me like there's a tide shifting to where there is more interest in engaging with people of the other side and less that it's tied to particular politics. I don't think it's a massive shift. I just feel like it's not further moving towards the further and further reaches of polarization. That's how it feels to me.

We might have different perspectives on that. I'm really glad to hear that. I think, I think we have had more nuanced conversations, but I think that's been a function of us. How do I put this without sounding arrogant? Becoming undeniable. Like, yeah. With respect to how the research is moving forward, it's not something you can brush under the rug anymore. And we're both in different ways making a certain amount of noise and people can see what's on the horizon. Like the, the movie that we saw on Friday, the Cholesterol Code movie, like it, you know, I'm definitely biased given the topic, but it was genuinely one of the best things I've ever seen in my life on, on screen. Like, and I include in there, and you know how much praise this is coming from me, I include therein consideration. Of Avengers: Infinity War. It was that good. It was so— are— yeah, done. And it, you know, when that drops later this year, that is something that's going to be absolutely undeniable and force conversations. I'm looking forward to having conversations because it's great and it's legitimate story, legitimate research, but great engagement bait. So be you carnivore or vegan, you're going to want to step up and have the conversation. That is like on steroids what we've seen thus far. Even things like Oreo versus statin Like our friend Simon Hill, which I think, you know, who we both respect, like I have to think the conversation I had with him and you had a conversation with him, but even my like solo podcast, 5 hours long, would not have happened if it weren't for Oreos versus Statin. Like he came and made a joke of it, like as I would have wanted him to do with the Oreos. He's like multiple Oreo themed gifts. We took pictures with Oreos. It's the engagement bait that, you know, people will jump at, be it Simon or Lane. And to Simon's credit, he jumps at it in exactly the way I want him to, which he's like, all right, you've made some noise. Now let's sit down and have the nuanced conversation. That is what I want. So that's why we do the things that we're doing to get the word out there, to have the conversations that do move needles and expand the tech.

Yeah. Well, the, the movie. That's— never has there been so much work that I've ever put into for what is ultimately, you know, 1 hour and 40 minutes of total time, of total runtime. It's crazy the amount of work that goes into that. And obviously I'm biased as well, obviously, but I have to agree. It's just an incredible piece of work. And there's so many amazing surprises that come out of that. But it's so, there was so much time, for example, that we put into the graphics and perfectly getting the narration just right. You already know how hard it is to just discuss lipidology, even for as much as we try to practice and work out our stump speeches and so forth. That had to have had, and I'm not even kidding, at least two dozen revisions just to get the wording just right. So I made sure. That it was layperson-friendly enough and I had to simplify some things, but in, I think, an acceptable way. I mean, certainly something would've popped out at you, you being as keen on all of the research as anyone else.

It was, it was so artfully, I was so impressed. And I'm, I'm definitely not just saying that. I, I, for, for what it's worth, I had not seen the film until Friday and we had filmed like at, you know, at my abode a couple years ago. So I didn't even remember a lot of the things that were happening. Yeah. I won't, I won't give the specifics of scenes, but there were parts of the movie, you know what I'm referring to, this footage of me and I'm like, is he gonna know more? And I don't remember this happening cuz it was so long ago and it was just like an off-the-cuff moment for me, but it was so artfully incorporated. Even down, like there are a lot of Easter eggs that I think if people watch it multiple times, they pick up on. Like I was commenting on the opening scene and the voiceover choice. Mm-hmm., and I was like, did you hear X, Y, and Z's voice? And everybody's like, what's that? I'm like, that was, I mean, that was artful. Yeah. But I think it was the kind of thing that went over most people's heads unless you listen for it. But the people who hear it and hear the actual words that said person is speaking that foreshadow the entire narrative. And given this person's profile, when you see the film, which you definitely should, you'll get what I'm talking about. I'm like, oh, that was a good setup.

I think it's going to be—

has ups and downs. It's scientific. It's centered around human stories. So many diverse human stories. I cannot imagine a single human being irrespective of their diet or political creed who would not be touched by this.

Without question. Everyone we've been wanting to talk about, to talk about this. I believe they're going to have to. Okay. Even the people who are not happy with this research, even the people wanna push back. I'm sure there'll be a lot of cholesterol code debunking videos.

Good luck.

Yeah.

Good luck. I'm telling you. Good luck.

But, but I honestly, you know, I'm excited because the one person who hasn't seen it who needs to see it is Dr. Budoff. Oh, as of this moment. But I think, uh, he'll be seeing it this Friday.

Great.

I'm, uh, I'm going to LA this Friday, so I plan to give him a showing and then I'll just brace.

But he doesn't really have any veto power, let's be honest.

No, but I'm pretty sure he'll actually be very happy with it.

I think so. Especially he came off very well.

I think he did too. And I think he'll be very happy with, as you know, the shaping of the things that I said and the, the way it was presented. Look, all of these documentaries these days, they, they feel anymore like just flagrant propaganda pieces. And I'm sorry, that's probably one of the most inflammatory things you'll hear me say, but they often just feel very one-note and very dismissive of concerns and very strong in their certainty. And I feel like we did such a good job of opening up uncertainty, of emphasizing what was great, but at the same time, what was preliminary and even opinions that might not be as intuitive.

Yeah.

From how everything was going in the course of the whole film.

Yeah, for sure.