Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz

Summary

Episode Summary: Rethinking Cholesterol, Keto, and Cardiovascular Risk with Nick Norowitz

In this enlightening episode of The Dr. Hyman Show, host Dr. Mark Hyman engages in a deep and thought-provoking conversation with Nick Norowitz, a Harvard medical student and Oxford PhD who has made remarkable strides in redefining the relationship between diet, cholesterol, and overall metabolic health.

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1. Nick Norowitz’s Personal Health Journey

[00:00] Nick Norwitz: "The Oreo cookies lowered my LDL by 71% in just 16 days. I think the top 10 drugs only help like 1 to 4 to 1 in 10 people who take them."

Nick begins by sharing his extraordinary experience of reversing chronic illness through dietary experimentation. Growing up in a household of medical professionals, he initially viewed nutrition science as “fluffy” and not grounded in real medicine. However, his battle with severe inflammatory bowel disease (ulcerative colitis) led him to explore various diets in desperation, culminating in the adoption of a ketogenic diet that resulted in complete remission of his symptoms.

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2. Understanding Metabolic Health Beyond LDL Cholesterol

[15:59] Nick Norwitz: "Metabolic health is when your body's systems are running in a way to optimize performance and minimize risk of chronic disease."

Dr. Hyman and Nick delve into the concept of metabolic health, emphasizing that it encompasses a range of biomarkers beyond just LDL cholesterol. They discuss how traditional medical models overly focus on LDL as the primary indicator of cardiovascular risk, neglecting other critical factors like insulin resistance, triglyceride to HDL ratio, and visceral fat. Nick introduces the metaphor of a "tree of metabolic illness," where addressing root causes such as insulin resistance can prevent multiple chronic diseases simultaneously.

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3. The Oreo Cookies Experiment: Challenging Conventional Wisdom

[35:00] Dr. Mark Hyman: "Just talk about this for a sec because I think it's fascinating. You're on a keto diet, your LDL is 500 and change, and you start to eat Oreo cookies along with your keto diet and you notice something radical happened. And you also tried a drug to do the same thing and the Oreo cookies worked better than the drug. Explain that."

Nick recounts his unconventional experiment where he added a sleeve of Oreo cookies daily to his strict ketogenic diet. Surprisingly, this addition lowered his LDL cholesterol by 71%, outperforming the effect of statin drugs, which typically reduce LDL by about 32.5%. [38:35] Nick Norwitz: "The Oreo cookies lowered my LDL by 71.1% in just 16 days."

This experiment was designed to provoke discussion and highlight the complex physiology behind cholesterol metabolism, especially in "lean mass hyper responders"—individuals who experience significant LDL increases on low-carb diets. Nick explains that in these individuals, ketogenic diets enhance fat burning and alter lipoprotein particles, resulting in higher LDL but also lower triglycerides and higher HDL.

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4. Critiquing the Current Medical Paradigm

[21:20] Dr. Mark Hyman: "Most drugs, most drugs don't work for most of the people who take them. They just work for a small section."

The conversation critiques the pharmaceutical-driven medical model, which prioritizes easily measurable biomarkers and drug interventions over comprehensive metabolic assessments. Both Dr. Hyman and Nick argue that the focus on LDL cholesterol and statin prescriptions overlooks more significant factors like insulin resistance, which poses a much higher risk for heart attacks. They advocate for a shift towards personalized medicine, where treatments are tailored based on a detailed understanding of an individual's metabolic profile.

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5. Personalized Medicine and N=1 Experiments

[43:09] Nick Norwitz: "I'm going to publish the results which were that the Oreo cookies lowered my LDL by 71.1% in just 16 days."

Nick emphasizes the importance of personalized, "N=1" experiments in uncovering effective health interventions. He argues that traditional randomized controlled trials (RCTs) are often ill-suited for dietary studies, which require individualized approaches. By empowering individuals to conduct their own health experiments—tracking biomarkers and personal well-being—Nick believes people can achieve remarkable health outcomes tailored to their unique biological makeup.

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6. Debating Dietary Approaches: Vegan vs. Carnivore

[53:54] Nick Norwitz: "You tolerate those foods. I think they're perfectly fine. And the fact I'm quite jealous. I love Brussels sprouts. They just don't agree with me."

The episode explores the spectrum of dietary approaches, from vegan to carnivore diets, and their impact on metabolic health. Both Dr. Hyman and Nick agree that no single diet fits all, advocating for a personalized approach based on individual biomarkers and health goals. They discuss how elimination diets, whether plant-based or animal-based, can be therapeutic for specific conditions like inflammatory bowel disease, but caution against blanket claims that one diet is inherently superior to others.

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7. The Role of Artificial Sweeteners

[86:31] Nick Norwitz: "There are really interesting data showing potential high impact harms like transgenerationally inheritable anxiety."

The discussion shifts to artificial sweeteners, particularly aspartame and sucralose, examining their potential adverse effects on mental health and metabolic function. Nick highlights studies suggesting that artificial sweeteners may contribute to insulin resistance and behavioral issues, advocating for informed dietary choices over relying on "diet" products as healthier alternatives.

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8. Future Directions in Metabolic Health Research

[75:03] Nick Norwitz: "I'm committing myself to. It's not because I don't think western medicine has this place that I don't think it's important. It's that... I think the biggest impact can be had from empowering individuals with knowledge about metabolic health."

Looking ahead, Nick shares his decision to forgo medical residency to focus on advancing metabolic health education and research through platforms like social media and Function Health. He aims to scale up efforts to disseminate knowledge about metabolic health, support personalized health experiments, and challenge entrenched medical paradigms that prioritize pharmaceutical interventions over dietary solutions.

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9. Conclusion: Embracing Curiosity and Personal Empowerment

[95:35] Nick Norwitz: "Stay curious."

Both Dr. Hyman and Nick advocate for a relentless pursuit of knowledge and personal empowerment in health decisions. They stress the importance of staying curious, questioning established norms, and leveraging available data to make informed choices that optimize individual metabolic health.

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Key Takeaways

• Challenging Conventional Metrics: LDL cholesterol is not the sole indicator of cardiovascular risk; factors like insulin resistance and triglyceride to HDL ratio are equally, if not more, important.

• Personalized Approaches: Health interventions should be tailored to individual metabolic profiles rather than adopting a one-size-fits-all diet.

• Dietary Experimentation: Personal "N=1" experiments can uncover effective strategies for managing chronic diseases and improving overall metabolic health.

• Critical Evaluation of Research: It's essential to critically assess dietary studies, recognizing potential biases and the limitations of large population studies in determining causation.

• Future of Metabolic Health: Empowering individuals with knowledge and tools to manage their own health can complement and eventually shift the broader medical paradigm towards more holistic, diet-based interventions.

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Notable Quotes:

• Nick Norwitz [00:00]: "The Oreo cookies lowered my LDL by 71% in just 16 days."

• Nick Norwitz [15:59]: "Metabolic health is when your body's systems are running in a way to optimize performance and minimize risk of chronic disease."

• Nick Norwitz [35:00]: "The Oreo cookies lowered my LDL by 71.1% in just 16 days."

• Dr. Mark Hyman [21:20]: "Most drugs, most drugs don't work for most of the people who take them. They just work for a small section."

• Nick Norwitz [43:09]: "I'm going to publish the results which were that the Oreo cookies lowered my LDL by 71.1% in just 16 days."

• Nick Norwitz [53:54]: "You tolerate those foods. I think they're perfectly fine."

• Nick Norwitz [86:31]: "There are really interesting data showing potential high impact harms like transgenerationally inheritable anxiety."

• Nick Norwitz [95:35]: "Stay curious."

This episode serves as a compelling call to reevaluate entrenched views on diet and metabolic health, encouraging both medical professionals and the general public to adopt a more nuanced, individualized approach to health and wellness.

Transcript

[Nick Norwitz]

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

[Dr. Mark Hyman]

Nick Norwitz is a Harvard med student.

[Nick Norwitz]

An Oxford PhD who reversed his own.

[Dr. Mark Hyman]

Chronic illness, and now he's redefining what.

[Nick Norwitz]

Science says about food and health.

[Unknown]

One of the most impactful steps toward enhancing our health and longevity is incorporating essential nutrients into our daily regimen. Among these, omega 3 fatty acids are.

[Dr. Mark Hyman]

Always at the top of my list.

[Unknown]

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[Dr. Mark Hyman]

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

[Nick Norwitz]

First of all, thanks for having me. I'm very excited to be here and have this conversation. As for my backstory, I grew up in a household of both My parents are MD, PhDs, and I always wanted to do medicine and science. I was always fascinated by biological sciences. I always had highest esteem for the medical profession. So that's always what I wanted to do as long as I can remember. That said, I had a very fluffy idea of what nutrition science really was. I think my understanding.

[Dr. Mark Hyman]

Fluffy idea.

[Nick Norwitz]

A fluffy diminutive.

[Dr. Mark Hyman]

It was kind of not real medicine.

[Nick Norwitz]

Yeah. It was one of those things where I think a lot of people still think, oh, I kind of know what healthy is. My plate. Before that, the food pyramid. Eat a balanced diet, eat your five a day. I would say a lot of platitudes, but platitudes that people take as gospel. I generally felt that way as well. I kind of knew, or I thought I knew what healthy was. You know, I eat my fruits and vegetables, not too much saturated fat, not too much salt, and then get enough energy to fuel my activities. And blessed or cursed, I don't know what you want to call it. I was a young person who never struggled with my weight. I was a pretty athletic young person. So throughout high school and most of college, I really didn't think much about my diet. And then things took a little bit of a left turn for me at the end of college when I started to develop inflammatory bowel disease. Before that, I was known, known as like colitis. Colitis, ulcerative colitis. So what that looks like for people who don't know, Sorry if this is a bit graphic, but bloody diarrhea 12 to 20 times a day.

[Dr. Mark Hyman]

Yeah, no fun.

[Nick Norwitz]

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

[Dr. Mark Hyman]

90 pound pounds, right?

[Nick Norwitz]

@ some points I was under a hundred pounds. I was so malnourished my heart rate was hitting like, you know, getting to the 20s. I had gone in the period of a couple years from apologies for patting myself on the back, but this was the reality. I was a top performing academic valedictorian in my college sub 3 marathoner, breaking like state push up records to being so frail that getting up and going to the bathroom costs more energy than running sub 3 marathons used to. And on top of that, you know.

[Dr. Mark Hyman]

My sub three hour marathons, that's a pretty good feat.

[Nick Norwitz]

Yeah, I mean I'm a pretty intense person.

[Dr. Mark Hyman]

Really? I didn't figure that out yet.

[Nick Norwitz]

Well, if you google one of the funny things I did. Yeah, when I get my mind on something, I never stop. 2014 Boston Marathon. This was the year after the terrorist bombings and I'd always wanted to do the Boston Marathon. So I qualified doing a sub 3 when I was 17, which actually made me the youngest time qualifier for the 2014 marathon. But if you look at my time for the 2014 marathon, it was just under seven hours and that's because I ended up breaking my tibia right before the race. So I did the whole marathon on crutches. Wow. Which I had to get special permission to do anyway. Back to Oxford. Yeah. No, I was. My quality of life had been completely destroyed. I was barely staying afloat with my studies, doing a lot of my work from the hospital. No social life, no romantic social life, really. Just had nothing beyond what was on paper for me.

[Dr. Mark Hyman]

And you basically were studying a keto diet, in a sense, or the exogenous ketones. Yeah. Like taking them not by diet, but actually by supplementing with ketones. Right.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Fat was bad and then that made you fat and fat causes heart disease and it's terrible.

[Nick Norwitz]

Yeah, yeah. So I. I had a very n. Negative perception of it. Now, how I ultimately found my way to it is after a couple years of trying standard therapy for ulcerative colitis, I just. I wasn't getting better.

[Dr. Mark Hyman]

And it was even the, like steroids and.

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

And immune suppressants and. Yeah, all the regular stuff.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Because there's a really key paper I read years ago about autoimmune paleo diet for ulcerative colitis and Crohn's disease. So it was very effective.

[Nick Norwitz]

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

[Dr. Mark Hyman]

The absence of evidence is not the evidence of absence.

[Nick Norwitz]

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

[Dr. Mark Hyman]

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

[Nick Norwitz]

So it hasn't been properly explored. And which makes it to me the low hanging fruit for treating all these chronic metabolic diseases which we have been poorly equipped to address. Cardiovascular disease, inflammatory bowel disease, obesity, diabetes, I'm mental health issues, mental health issues as well.

[Dr. Mark Hyman]

So whole departments of metabolic psychiatry now we've had, I know from Stanford on the podcast.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Well, most drugs, most drugs don't work for most of the people who take them. They just work for a small section.

[Nick Norwitz]

I think 1 to 4. I think the top 10 drugs only help like 1 to 4 to 1 in 10 people who take them.

[Dr. Mark Hyman]

I mean, like statin, you have to treat, you know, eight or nine people for five years to prevent one heart attack one day. It's like, not very good.

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

So, Nick, your. Your story is very compelling, and I think you. You came to a sort of a personal choice about your own diet and health, but it led you down this sort of rabbit hole of metabolic health.

[Nick Norwitz]

Right.

[Dr. Mark Hyman]

So people listening, I don't know if they actually understand what does it mean when you say metabolic health? I mean metabolism. I have a slow metabolism. You know, what does that mean? I burn calories fast. But people don't really understand what metabolic health means. Can you define it?

[Nick Norwitz]

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

[Dr. Mark Hyman]

Essentially you're talking about the spectrum of like imbalanced blood sugar and insulin to pre diabetes to type 2 diabetes.

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

And you don't have to have actually the type 2 diabetes to experience many of the consequences of poor metabolic health, including heart attacks, strokes, cancer, Alzheimer's, mental health issues such as bipolar disease, schizophrenia, depression, the list goes on and on. Adhd, autism.

[Nick Norwitz]

Right.

[Dr. Mark Hyman]

And it's sort of fascinating how these seemingly unrelated diseases, I mean, what does autism have to do with diabetes?

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

Or what is Alzheimer's have to do with cancer? But yet they're connected by this common thread of poor metabolic health and metabolic dysfunction.

[Nick Norwitz]

I think a way to think about it is. I don't know if I came up with this analogy. I can't imagine I did. But that of the tree of metabolic illness, where, you know, if you look at a tree and you look at all the different branches, you can see each different branches of disease, obesity, diabetes, cardiovascular disease. The way we go about modern medicine now is trying to prune the tree as the branches grow. The fact of the matter is they're just going to keep growing back. And I think the mind shift we need is to look at the, you know, roots in the soil, which are these underlying pathologies, things you mentioned, like insulin resistance and inflammation.

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

That are at the root of all chronic metabolic disease. And when we make that mind shift, we can, you know, gain insight into, I think, how we can more potently address disease and also why certain fundamental interventions might hit a lot of different diseases like, yeah. Depression and schizophrenia in addition to obesity. And it's not because it's snake oil, it's because they all have the same underlying dysfunctions that just manifest differently in different people with different susceptibilities.

[Dr. Mark Hyman]

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

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

Which is 37 billion trillion chemical reactions every second. From a top line medical definition is when we think of what is metabolism?

[Nick Norwitz]

Right.

[Dr. Mark Hyman]

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

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

And it is driven by the amount of sugar and starch in our diet that's driving our metabolisms to be broken in some way and to not function as they were designed and to do all the opposite things we wanted to do. You sort of came to a ketogenic diet for your own autoimmune disease, which makes sense, but it's kind of an unusual application. Right. And I think it's worked for you, which is great. And I'm glad you're well and I'm glad you're doing what you're doing. But I think the deeper question is really, as a society, we're now facing a staggering number of people with broken metabolisms or severely to moderately to mildly. But somewhere in the spectrum, that's driving them to poor health, and it's costing our society trillions of dollars. It's creating tremendous amounts of loss of productivity, it's threatening our national security, it's threatening our global competitiveness, making us all feel like. The question is, what is the biology underneath it? And let's just unpack it and then let's talk about, you know, the, the different kind of approaches to it. Because I think there's a lot of views on this. You should be vegan, you should be carnivore, you should be low fat, you should be high fat, you should be keto, you should be paleo, you should be Mediterranean, you should be. I mean, it makes people crazy. I mean, I think that's why people just throw up their hands. I'm just gonna eat pizza because I don't really know what to do. You know, we now actually have an interesting test which I had the first patient I've had who be able to do this test request called the insulin resistance score, where they measure C peptide and insulin through a special technology called mass spectrometry that is a very predictive marker of insulin resistance. As good as you get in the science lab, where you do very fancy invasive tests to measure your insulin resistance. And, and it's something that I think every American should have measured. It's something that we actually now offer through Function Health, which is a company I co founded that allows people access their own biology and their own data and their own labs. And it's now available, and I think it probably should be like the most important biological test. And yet most doctors never measure insulin. They never test it, they never look at it. They don't interpret it. The reference ranges are completely screwed up on the QUEST laboratory because they say it's normal up to 18. It should probably be less than 5. And so we have this moment where we're in this metabolic crisis. We have this broken metabolism. We have it driven by our diet that's high in starch and sugar and processed food, which is really the vehicle for it. And it's creating all these downstream problems. And as you refer to it as sort of like this sort of trunk in the roots rather than the branches. And this is exactly the metaphor we use in functional medicine. I don't know if you're aware of that, do you? Are you aware of that?

[Nick Norwitz]

That metaphor?

[Dr. Mark Hyman]

That exact metaphor.

[Nick Norwitz]

I figured I hadn't. I might have, like, heard. I don't know where I heard it, but I'm like, I couldn't have created this. It's just so obvious.

[Dr. Mark Hyman]

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

[Nick Norwitz]

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

[Dr. Mark Hyman]

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

[Nick Norwitz]

Right?

[Dr. Mark Hyman]

Because doctors have no training in nutrition.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Or, and in English, that means if you have Alzheimer's, it could suck out the immune cells, can help suck out bad proteins and put in healthy new.

[Nick Norwitz]

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

[Dr. Mark Hyman]

I'm going to come back to the Oreo cookies study.

[Nick Norwitz]

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

[Dr. Mark Hyman]

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

[Nick Norwitz]

So what I would say is they.

[Dr. Mark Hyman]

Can'T figure it out. How. What am I supposed to do?

[Nick Norwitz]

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

[Dr. Mark Hyman]

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

[Nick Norwitz]

Right.

[Dr. Mark Hyman]

And that, that just isn't true. You know, like I, I had a, I just had a. Cuckoo stories. And then we'll sort of dive into this, sort of, this concept of that, that I think you guys have been working on a lot at Harvard and that you and my, my buddy David Ludwig, who's one of your mentors has talked a lot about is sort of the role of, of low glycemic diets in the, in the role of treating metabolic dysfunction. And you know, I had a patient who was really struggling, their weight very inflamed, very and terrible cholesterol like 300, total cholesterol 200 plus LDL. Triglycerides like 350-400HDL like 30 something. It was a walking disaster. Insulin levels through the chart and then we did even need a glucose tolerance test. In her post prandular after eating insulin was super high as well as her glucose. So she was in the pre diabetic range. Another guy was a 55 year old like biker who like just crushed it every day 50 miles in his bike. Lean, fit, healthy. Both of them had heard about a keto diet. And I, I said to this woman, I said, you know, I think this might be really helpful for you. Why don't we try it? And she did. And her cholesterol dropped 100 points. Her triglycerides dropped 200 points. Her LDL dropped like 150 points. Her HDL went up 30 points. It was, you know, it was remarkable without any drugs. Whereas the other guy, his lipid particles went like sky high, his LDL one, sky high. And I was like, well, what should we do? Like, what do you do? And, and I think there's a movie that you were involved with called the Cholesterol Code. This guy named Dave Feldman, who's done a lot of work, who's an engineer, basically decided he was going to take this on as a project, you know, basically to show the world what happens when you have a whole group of people who are lean, fit and healthy who go on a keto diet, but their LDLs go through the roof, whether it's 1002-003004-00500, 600, 700. And it, it freaks doctors out. In this movie and in some of the literature, it's like you actually get better lipids and virta health. And we've had Sammy on the podcast who started Verta Health. You know, you see with these type 2 diabetics, when you look at all their cardiovascular biomarkers, when they go on keto and they're eating high diets, fat and even saturated fat, their numbers all improve and, and yet others don't. So how do you kind of make.

[Nick Norwitz]

Sense of all that to frame up why this is so important? I would first say that we've already mentioned that carbohydrate restricted diets can help with a broad range of conditions, with ketogenic diets potentially helping with like severe mental illnesses, depression, schizophrenia, bipolar stuff that's.

[Dr. Mark Hyman]

Really untreatable and intractable most of the time, truly.

[Nick Norwitz]

But however, there's a obstacle to clinical implementation of these diets broadly, and that is some people have these astronomical jumps in cholesterol, in particular LDL cholesterol, and that scares physicians. Just reinforcing what you said. But the reason this is so important is it's a deterrent from prescribing these diets to people who could genuinely benefit from them as a metabolic health therapy. So it's a critical question to answer one who is susceptible to these increases in ldl? Because it's only a minority of people. So it's a minority, but it is a decent population. Why in some people and not others, we need to identify that population, what's the mechanism, and then also what's the risk associated with the high LDL in different context. And we need this information in order to promote the adoption of ketogenic diets for a broad range of conditions and properly Treat people on an individual basis. So with that framing, I would say one really interesting observation that explains why only a minority of people see increases in LDL on low carb ketogenic diets is that there is an inverse association between your, your BMI and LDL change, meaning the leaner you are, the higher your LDL goes.

[Dr. Mark Hyman]

Now, if you're very overweight and you're obese and you're diabetic and you go on an extremely high fat diet, your LDL goes down.

[Nick Norwitz]

It tends to.

[Dr. Mark Hyman]

So, whereas, whereas if you're fit, thin and healthy and neck and an athlete.

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

And you want a keto diet for various reasons, like mental health or gut health or whatever. One of the issues, your LDL goes through the roof. Like yours, yours is like 500 or something, right?

[Nick Norwitz]

Mine's like 500, 550. So. And we can get into the saturated fat or something later.

[Dr. Mark Hyman]

But which would make, which would make carb. Most cardiologists have a heart attack.

[Nick Norwitz]

Right. Ironically, this is, this is true. We can talk about my profile later, the contributions to that. But with respect to the literature, we did a meta analysis of the 41 human randomized control trials with low carb diets where we had the information to look at LDL changes and lipid changes. And what we found was if you broke it up by BMI category, the only group of studies where LDL went up was BMI under 25, the lean group, overweight, class one obesity, no increase, class two obesity. LDL actually went down. And if you looked at the individual participant level data, there was an inverse association across the BMI spectrum where the leaner you were, the higher your LDL went. So this is encoded in the human randomized control trial literature. And I'll give a big hat tip to my friend Adrian Sotomoto, who is the guns behind that one, the first author, and then David Ludwig we worked with on that paper.

[Dr. Mark Hyman]

What happens when people who are obese and diabetic become thin and fit and healthy and have more mass?

[Nick Norwitz]

That's the fascinating thing.

[Dr. Mark Hyman]

So do they flip over to the other side?

[Nick Norwitz]

I've seen this happen. I've seen. I'll give you one instance, was a patient with a starting BMI of 43.2.

[Dr. Mark Hyman]

That's big. That's very big.

[Nick Norwitz]

And actually had low LDL baseline, like in the 80s. Despite that, I mean, they had high triglycerides, low HDL and probably a pattern BLDL phenotype, but they had lowish LDL at 80. They started losing weight they went on a ketogenic diet. They were losing lots of weight, BMI went to 30, 27, and right around BMI, 26, 25, their LDL took a hairpin turn where it was more or less stable, sub 100, and then shot up to 250. Just shot up as they got. They didn't really change their diet at all. They just got into this lean area and their LDL went through the roof. So as a practical takeaway to people and things I'd highlight for the healthcare practitioners, listening is like, if you have a patient with insulin resistance, type 2 diabetes, obesity, and you're interested in trying a ketogenic diet for them, they're very unlikely to see the LDL change that might scare you. They're unlikely to have that response. There might be a transient bump that's small that comes back down. We do see that in the literature. But as for this, like, jump to 400, you're unlikely to see it. So I think a few things really need to be reconciled that are points of concern. Confusion around this are terms like, you know, LDL is causal and necessary for cardiovascular disease. In this idea of context, dependency. So what I'm not saying is that LDL or APOB don't matter. I'm also not saying they're not part of the causal cascade. They are. But just because something is part of a causal cascade and necessary doesn't mean you need to treat it, because context matters so much.

[Dr. Mark Hyman]

What do you mean by context? Well, the context of the rest of their metabolic health.

[Nick Norwitz]

Their metabolic health is one element of context, the context around, like, what is actually driving up the biomarker. Because biomarkers can change for different reasons. And you can start to gain insight into why a biomarker might be where it is when you start to know the whole patient story. Yeah, which is why, again, I teased it. But, like, I legitimately can lower my LDL with Oreos more than I can with a statin that is not generalizable. But it comes down to the context. Because we understand the physiology, you can get amazing results.

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[Dr. Mark Hyman]

Just talk about this for a sec because I think it's fascinating. You're on a keto diet, your LDL is 500 and change, and you start to eat Oreo cookies along with your keto diet and you notice something radical happened. And you also tried a drug to do the same thing and the Oreo cookies worked better than the drug. Explain that.

[Nick Norwitz]

So first, why I did this. People are going to say, well, isn't this clickbait? Oh, 100%. It was engineered to be clickbait. I was trying to engineer the most clickbaity experiment I possibly could to start a really important discussion about fascinating physiology. So it was clickbait backed by legitimate science. Now, at the point I designed the experiment, we had already had about 10 papers on this topic. One, they weren't getting talked about, I think enough. And two, there was, there were what I perceived as efforts to not only suppress the dialogue, but circumvent it with misleading messaging. Intellectually misleading messaging. I can support that. I realize that sounds like a strong claim. I'll give examples later. But with the resources available to me, at the time I was 27, I was like, how can I force this discussion? I am, you know, not a esteemed professor emeritus. I do not have millions of dollars. I don't even have that big a social media profile at the time.

[Dr. Mark Hyman]

But you can afford a pack of Oreos.

[Nick Norwitz]

But I can afford a pack of warriors per day. And so I'm like, I want to engineer something that you know will catch attention and hopefully bring people towards a more nuanced discussion that needs to happen. So I designed this study and to be clear, I designed it and announced it before I did it. I thought it was the appropriate scientific thing to do. Saying like, this is my prediction based on my understanding of the physiology, then I'm going to do it.

[Dr. Mark Hyman]

It's your hypothesis.

[Nick Norwitz]

My hypothesis. I announced it on. You can even look. Chris McCaskill by Plant Chompers is a prominent Vegan, I announce it on his platform. And I said what I'm gonna do is an experiment. In this experiment I'm gonna lock in my diet as a kind of strict baseline ketogenic diet, my normal one for a couple weeks. And then I'm gonna do an intervention where I eat Oreo cookies a sleeve per day. So that's 12 cookies, about 100 grams of net carbs in addition to my diet. So I'm not swapping out fat, I'm adding this. I'm actually adding saturated fat along with sugar and carbs for about two weeks. And then I'm gonna do a washout period, kind of reset. Everything ended up being a three month washout period. And then I'm going to try high intensity statin therapy. So it was Crestor 20mg for six a week.

[Dr. Mark Hyman]

Gorilla statin, very high dose. Normal dose is 5, 10, you know, is good and 20 is a lot.

[Nick Norwitz]

I wanted to steel man the comparator which in this case was, you know, frontline therapy, statin therapy. In addition to this I know how to dot my I's and cross my T's. So I went to Harvard. Their institutional review board got the appropriate exemptions for this experiment, had my PCP ordering all my labs into my electronical medical record. And then I got a consultant lipidologist. I don't know if you know Professor William Cromwell, but he trained Thomas Dayspring, Thomas Daystring trained Peter Attia in lipidology. So William Cromwell, over 30 years of experience. He's the senior author on this paper and was consulting. So I did this as buy the books as you could. An Oreo experiment.

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

And then I executed and published the results which were that the Oreo cookies lowered my LDL by 71.1percent in just 16 days. Now the reason it was 16 days and not 14 I had mentioned two weeks was because at the the two week mark the drop was so astronomical we wanted to make sure it wasn't a lab error. So we wanted to triplicate. So we say we're going to measure the next two days and it was still dropping. So that was the effect of the Oreo. And then the statins lowered my LDL by 32.5%.

[Dr. Mark Hyman]

So the more than double the effect.

[Nick Norwitz]

Of the in one third of the.

[Dr. Mark Hyman]

Time by eating Oreos. Explain that because that doesn't make any sense to most people listening.

[Nick Norwitz]

It comes down to explain yourself doctor Me understanding the physiology in myself. So talked about different things can drive biomarkers up or down and the context matters. So our understanding of why lean people have high LDL and low carb has to do with the fact that the leaner and the more insulin sensitive you are when you go low carb, when you go keto, and the carbohydrate stores in your liver start to drop, it kicks off this cycle whereby you're burning a lot more fat as fuel and you're actually releasing more free fatty acid from your fat cells into your bloodstream. And then those free fatty acids need to cycle throughout the, the, the liver and then back through the body. So they get taken up by the liver, packaged on these big ship like particles containing cholesterol and stored fat. They're called vldl. And then the vldl drop the stored fat, the triglycerides back off at the muscle tissue and the fat tissue. And what happens in this process is those that those big particles that are packed with the stored fat have the fat siphoned out of them. They shrink down into LDL particles that contain LDL cholesterol. And what you end up with as a result of this system is very high ldl because you need it to.

[Dr. Mark Hyman]

Transport the energy around your body so you can use fat as fuel.

[Nick Norwitz]

It's like a decay product of the thing that was transporting the energy effectively in an epin phenomenon. So, yes, there are these particles that are the precursors to ldl. They drop off their cargo, the fat, at fat tissue, to replenish small fat cells and muscle tissue, and then the VLDL will shrink.

[Dr. Mark Hyman]

VLDL is like a more like less triglyceride rich particle.

[Nick Norwitz]

The VLDL has a lot of triglycerides in it. It drops off the triglycerides and becomes an LDL which sticks around longer than the vldl. So what you end up with is actually very low triglycerides, because the triglycerides get sucked out so fast. Triglycerides are low, not high. Your LDL ends up being very high because the VLDL are being turned over really, really quickly into ldl. And then as an added nuance, when the VLDL shrink, remember, they're big spheres. They lose surface components from their shell, you could say. And some of that is cholesterol that gets picked up by hdl. So the result is this pattern of very high ldl, high HDL, and low triglycerides. The high ldl, the high hdl, the low triglycerides with particular thresholds is what we call lean mass hyper responders and is this pattern we see on lean people who go low carb. We can get a little bit more into the model if you want. But the point is, the model starts with your metabolism shifting towards lots of fat burning. So if you put carbs back into the system, it puts the brake on the system or at least takes the foot off the gas pedal. And your LDL should drop. That is the prediction of the model. So it should drop with any carb. The fact of the matter is, even before I did the Oreo, it could.

[Dr. Mark Hyman]

Be a sweet potato Oreo, we had.

[Nick Norwitz]

Used sweet potatoes in patients. There are case reports on this, or fruit or starches. It just wasn't sexy enough to catch headlines. So I'm like, like, what is? And I'm like, oreo cookies. That should do it. So I did it in a rigorous controlled experiment with, you know, my locked in baseline diet, a pure addition. You can look at all the macro breakdowns in the paper. And the result was the Oreo cookies lowered my LDL by a dramatic 71%. And I'll just say as an aside.

[Dr. Mark Hyman]

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

[Nick Norwitz]

Right?

[Dr. Mark Hyman]

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

[Nick Norwitz]

Well, the fact of the matter is, I think you learn so much in science and metabostin by studying the outliers. And when you do the randomized control trial, yes, it has certain benefits, but your by the nature of the study, looking at a large group of diverse humans. So when you get a, quote, statistically significant result that doesn't speak to any individual in the trial. And if we want to shift medicine towards more focusing on targeting underlying metabolic dysfunctions in an individual manner, then we need to start taking the mindset of N equals one medicine. And we have more and more tools where we can do this. Things like multiomics, where we take an individual's like genome and microbiome and transcriptome, you integrate them into an incredibly high resolution picture of the individual. If you take that mindset, then you can get incredible results in a reproducible manner, like lowering your LDL with Oreo cookies. I'm not saying that's healthy. I'm Just saying. It's incredible.

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

And it's explainable when you understand the physiology. And is it generalizable. I've actually had other doctors at Harvard replicate this who are lean mass hyper responders. They're actually quite a. A decent number of lean mass hypersponders. People at keto at Harvard. Harvard. And I get text like a lot.

[Dr. Mark Hyman]

A lot of subterranean keto community at Harvard.

[Nick Norwitz]

Atheists in the clergy. Yeah, you'd be surprised. Keto carnivore who are.

[Dr. Mark Hyman]

Who are in the medical community.

[Nick Norwitz]

Yeah, I mean, they.

[Dr. Mark Hyman]

Not just sort of like studying history, but.

[Nick Norwitz]

No, I know senior attendings who are like carnivore lean mass hyper responders. And they're not out about it because it's stigmatized. They don't want to deal with the headache that has that comes with like, putting that target on your back. So most of the time, like a paper will come out and they're like, nick, did you see this BS about red meat? Will you respond to it? I'm like, you want to get up there with me? And they're like, no, no, you do it. It's true. It's a very stigmatized dietary pattern. Keto, and to a greater extent, carnivore people, generally, be they your person in the general public, or a senior MD, PhD, are gonna do what makes them feel good. And so if that helps them function and feel good for whatever reason, they're probably gonna do it. They might not be out about it.

[Dr. Mark Hyman]

So let me sort of back up. Cause you covered a lot. I wanna make sure everybody listening. You're Harvard, Oxford, Maryland, PhD. And most of us, including me, are not that smart. So let me see if I got this. First of all, there's a big heterogeneity in the population, meaning there's a lot of differences depending on your genetics, your metabolic type, and how you respond to different foods at different times. And that's really important, that there is no one size fits all. Number two, that our whole hypothesis that LDL is the boogeyman V with a capital T H E may be starting to see cracks in it. In its theory that keto is something that can actually help reverse a lot of the broken metabolism that affects us as a population, including across the spectrum from autism to Alzheimer's to cancer, diabetes, and even mental health. Things like depression and schizophrenia and bipolar disease. This is just kind of a radical idea that there'd be like one quote drug that could treat so many different problems because it hits this simple, common route. I'm not sure. That cardiologists have caught up to this idea that LDL isn't the whole story. In the subtext of. Also, what you said was that a lot of other biomarkers may be more important than ldl.

[Nick Norwitz]

Are more important. I would say. Are more important.

[Dr. Mark Hyman]

Okay. Okay. I was just. Maybe. Well, I'm trying to be more. More like scientific and say may because. Because I think, you know, some people still are questioning this. Like, the. The basic orthodoxy is the only thing that matters to measure is ldl.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Yeah. It's interesting. When you look at insulin resistance, it's six times greater a risk factor for.

[Nick Norwitz]

Having a heart attack Woman's health study.

[Dr. Mark Hyman]

Than having a high ldl.

[Nick Norwitz]

I think it's even more.

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

I think the. The. This might have even been in a documentary you were in. But you're talking about the Women's Health Study. And I think the hazards ratio for a high lipoprotein insulin resistance score was six plus.

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

And for LDL was like 1.38. And since one is nil. A lot more than six. Yeah, whatever. You know, 500 divided by 38.

[Dr. Mark Hyman]

It's a lot. It's a lot more. And then even more is like triglyceride to HDL ratio and APOB and a lot of other biomarkers. Insulin.

[Nick Norwitz]

Right.

[Dr. Mark Hyman]

Inflammation. All may be more important than ldl. And yet the thing we focus on is LDL cholesterol, because that's what's easy to measure in a lab test at your doctor's office checkup. And it's easy to give a prescription. Everybody feels good and goes home and thinks everything's great. But the truth is, we're missing a lot. And actually, statins don't really treat underlying metabolic dysfunction, and they actually, I don't think, even really help with correcting the quality of your cholesterol. They don't affect the small particles as. And they may reduce total particles and. Which may be helpful, but they don't actually improve the size of your cholesterol particles, which happens when you eat a higher fat diet, which is what's so remarkable. And as we come to sort of understand the nuances of cholesterol. And this is why at Function Health, we measure your lipoprotein fractionation, we measure Insulin, we measure A1C, we measure your. Your APOB, we measure LP, we measure A lot of the things that are not being looked at to round out the picture of what your overall cardiovascular risk is. We even are measuring qualities of hdl, which most people don't think about that you can.

[Nick Norwitz]

That's a complicated sphere.

[Dr. Mark Hyman]

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

[Nick Norwitz]

So, right.

[Dr. Mark Hyman]

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

[Nick Norwitz]

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

[Dr. Mark Hyman]

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

[Nick Norwitz]

They do.

[Dr. Mark Hyman]

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

[Nick Norwitz]

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

[Dr. Mark Hyman]

I'm saying kill the planet. Climate change. Yeah.

[Nick Norwitz]

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

[Dr. Mark Hyman]

The reason I say I'll put it aside because I've written a lot about, I talked a lot, I wrote about my food folks, food, what they should eat and.

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

And other books, Food fix. And I basically came up with these exactly what you said. There's like three basic issues. It's health impact, environmental impact and it's moral. It's moral implications.

[Nick Norwitz]

Right.

[Dr. Mark Hyman]

And so those are all separate. Like if you're, if you're morally opposed, there's nothing I can do to really make the argument against you. If that's your core values and belief, God bless you.

[Nick Norwitz]

Right.

[Dr. Mark Hyman]

As far as the environment and planetary issues, there's a lot of flaws in that argument and has to do with regenera versus CAFO arguments. And again, that's why I wanted to leave that aside. I really want to get into the sort of biology of, from a health perspective, you know, and you know, up Till I think 1940 something, there wasn't a word for a vegan diet. There's been no, historically, vegan, vegan populations on the planet at least who wanted to be vegan. And everybody's looking for meat because it's the most dense form of nutrients. It's the most nutrient dense, nutrient rich form of nutrients that you can consume to grow and thrive.

[Nick Norwitz]

Well, I would say, by and large I'm Diet agnostic when it comes to metabolic health. And what I mean by that is the great thing about metabolic health is the proof is in the pudding how you feel in your biomarkers. So if an individual achieves great health, biomarkers, disease remission on a vegan diet, I will applaud them and be happy for them.

[Dr. Mark Hyman]

Have you seen that?

[Nick Norwitz]

I've seen people who profess to it. I mean, I believe it's doable, I believe it's not necessarily easy, it might require supplementation. I believe it is possible. I don't have any reason to like fully doubt it. And I will give that the benefit of the doubt. I don't think it's a fair assumption, which is often a common assumption that eating the higher proportion plant based you can eat the healthier you are. I think that is a problematic reasoning. Again, it comes down to biomarker. Well, not biomarkers, but like what is the proof, how are you actually doing and what does a particular dietary intervention actually do to you? So I'll give an example where I can actually construct a scenario where I go from a very saturated fat rich, animal based carnivore esque diet to a vegan diet and spike my LDL and Apple B. I've done this. I have the video breaking down how I did it. Yes, it's a party trick. Nevertheless, it's again legitimate and resulting in a change in a biomarker that I would say the vegan community thinks is particularly important. Probably ldl.

[Dr. Mark Hyman]

Yeah, I mean that's really, it's just.

[Nick Norwitz]

Like throwing the wrench in there of saying, look, there's so much context around this that do whatever you want with your diet, but don't be deluded to think that just eating more plants is gonna make you healthy.

[Dr. Mark Hyman]

Yeah. Test, don't guess is my motto.

[Nick Norwitz]

I like it.

[Dr. Mark Hyman]

Test, don't guess. I mean, look, I can say God bless you. Whatever you want to do with your diet, do it. But track how you feel, track how your body systems are working and track your biomarkers. Get data on yourself because if you start to get real data, you begin to see like, and I've seen this, you know, people who even want to profess to be healthy vegans. I'm not talking about the chips and Oreo cookies and Coca Cola vegans, I'm talking about people who are trying, they're often more insulin resistant, they often have more lipid particles, smaller lipid particles, they have higher triglycerides, they have lower hdl, they often have lower levels of many nutrients, including zinc, iron, vitamin D, omega 3 fats, iodine, and kind of list goes on. And I measure these things. So I'm not doing it based on some belief or theory. I'm doing it based on just being a keen observer of data in the population that I've treated for 40 years. And even one patient who was so morally committed to being a vegan, we did her anti mullerian hormone, which is a measure of fertility. She's 30 years old and she was like, had the fertility levels of someone who's like in her late 40s and she wanted to have a baby. I'm like, this isn't good for you. And here's all the nutrient divisions you have. And also you look pale and sallow. You might want to consider changing your diet. And she did, and immediately she was able to get healthy and get pregnant.

[Nick Norwitz]

All right, I'm going to tease you before I talk about carnivore Brian Johnson. Is he healthy?

[Dr. Mark Hyman]

That is a great question. I think he says he feels healthy and his biomarkers are good. I think he, he does what I think most vegans who want to be as, as fit as he is and have as much muscle as he does, he supplements with processed plant protein powders that are most likely spiked with amino acids. Because the, the, the, the concern I have around, you know, people who are, are saying they're healthy, athletic vegans is they can't do it on a pure vegan diet that you have to supplement in some way. For example, if you want to get, you know, 30 grams of protein, you can eat 4 ounces of steak with 250 calories. If you want to get that from brown rice, you got to eat six cups and it's a thousand plus calories. And that comes with all sorts of other implications of who's going to eat six cups of rice. And you know, what does those thousand calories doing to your blood sugar, insulin and so on and so forth. So I mean, and they go, well, but look at, in China they eat a lot of rice. And it's true. I mean, I traveled around in China in the 80s and I was in medical school at the time. And there were these super fit, thin, athletic looking, lean Chinese who were working in the rice fields 12 hours a day, who would come in and eat like a giant bowl of rice and vegetable on top. And they were able to do it because they burned through it. I mean, if you're a marathon runner, you'll burn through it. But that's not most people. It's an interesting kind of framework where we have to start to look more at what happens to individuals when they try these things and look at, honestly at their own biology. And that's part of why we co founded Function Health, which is to give people access to their data, not just having to go to the doctor. Please beg. Can I please measure my insulin? Can I please measure my apob? Can I please measure whatever you can do it, it's your body, you should pick and choose what you get to do with it.

[Nick Norwitz]

One thing you said there stood out to me, which is not for most people, and I think something we both agree on is that it doesn't really matter what works for most people. If it works for you at the end of the day with that, it's probably a good transition to talk about benefits of carnivore.

[Dr. Mark Hyman]

And, and what are the, like what are the, what are the benefits? And also the challenge you see on terms of the vegan side. I mean, yeah, you know, because I think, you know, historically as populations from an evolutionary biology perspective, we've been more carnivore than vegan. Right.

[Nick Norwitz]

We got most of our protein sources from animal based foods I think for most of our evolutionary history.

[Dr. Mark Hyman]

And there are certain populations that, you know, have more plants and you know, if you're 40th latitude and you're kind of in the equator zone, you're going to probably have more plants to eat than if you're in the tundra of Alaska or somewhere and you're gotta live on whale meat and stuff.

[Nick Norwitz]

But one would also argue that like when we were evolving, there wasn't a selection pressure for like longevity, that our priorities as individuals and organisms have shifted. So how far can the evolution perspective really take us in assessing what's best for our health?

[Dr. Mark Hyman]

Okay, so let's talk about carnivore.

[Nick Norwitz]

I mentioned earlier in the pod that I had a very negative view of keto before I started it. But over time I've developed an interest in probing areas of taboo. Carnivore is definitely one of them. When it came up on my radar, my first response was like, this is absurd. I can only meet diet. This can't be healthy for you. Despite how I'd changed my mind on things before, but I like playing devil's advocate. So I started to dig into it a little bit more and what I found was that there was actually a lot of basic physiology and biological plausibility to align with some of the things that people report clinically on a carnivore diet. Like remission of inflammatory bowel disease, which is obviously of interest to me. So since that point in time, I've been delving into it as a topic a little bit with respect to, you know, writing case series. We had one on a carnivore diet for anorexia because that's obviously very controversial one for a carnivore diet for inflammatory bowel disease where we're like, you know, we did full medical histories, we had lab reports, colonoscopy reports, and we interviewed, I interviewed like 10 patients. And to hear their stories, people saying like, you know, that they had had Crohn's or colitis for a couple decades, been through a litany of immunosuppressants, been through surgeries, and this was the first thing that really like brought them back to life and gave them a new life. Like, you can't ignore that.

[Dr. Mark Hyman]

No.

[Nick Norwitz]

Especially when, you know, it's, it's dozens of people. Ten were reported, but there are many more. And then you square that up with physiology, that actually makes a lot of sense. Like carnivore is usually keto. Ketones in the gut reduce inflammation. Higher ketone levels in the gut associated with lower IBD activity. There's even literature showing how fibroid elimination can have a therapeutic effect via changing called mucospirillium. I think a pathobiont on the gut that can put pediatric Crohn's disease into remission. I didn't know before studying it, but actually fiber free liquid diets are quite commonly prescribed for refractory prediabete elemental diets. Yeah, yeah. It's like 60 to 85% of cases respond. They don't teach you that in medical school because it's like it, you know, I guess heresy against the beneficial effects of fiber. But say for that particular use case, I was seeing so many stories, and when I say stories, I do mean like with medical histories, lab reports, colonoscopy reports that are just overwhelming along with interesting physiology. And it comes back to this question of. Or the topic of absence of evidence isn't evidence of absence. Like nobody's done the three to five million dollars randomized control trial of a strict carnivore diet versus a vegan diet for ibd. I have my hypotheses about how it might turn out. I'd like to see it done. But that's the reason this isn't, or a reason it's not prescribed is because the studies haven't been done. It doesn't mean it can't really benefit People coming to that realization and feeling it's the intellectually honest thing, then abuts against some of the what I would call intellectual dishonesty I see in the media and the scientific literature around carnivore diets. I'll give you a case in point. Did you see that JAMA Cardiology case report that came out about the plaques on the hands? The yellow nodules was over all the. Yeah. So there was a report that came out a few weeks ago as we recorded this. It was in JAMA Cardiology. It was a case report of an individual who went on a carnivore diet and had, they say, cholesterol oozing from his skin, if people want to Google it. And there's these pictures of these yellow plaques on his hands from eating, presumably a carnivore diet. Now you look at the report and it was word limited, but you look at the report and the entire description of the patient was a man in his 40s. That was the description. Didn't even give his exact age. No medical history, no family history, no genetic history. And they described his diet as him eating six to nine pounds of cheese, butter and beef daily.

[Dr. Mark Hyman]

Wow.

[Nick Norwitz]

Which is actually implausible. So this didn't read like a case report. This read like a skit from Monty Python. You know, like the Fat Man. I'm like, this is not plausible. How did this get published?

[Dr. Mark Hyman]

Right.

[Nick Norwitz]

I'm all for cautionary tales, but this is intellectual dishonesty.

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

And if people actually do read the report, it was worded a little bit vaguely around his diet. The first author did get on the news, I think it was Fox News, and doubled down on the fact that he was reporting six to nine pounds of cheese, beef and butter intake per day again for eight months. Implausible. This isn't a legitimate report and nevertheless.

[Dr. Mark Hyman]

It do something I understand. Like four ounces is like the six ounces is a normal portion of meat that it's like four times. That is a pound. You're talking about nine times four. You're talking about.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

And that is what's dangerous. Trust is lost in science and medicine. So now why are they going to believe anything else that comes out of JAMA Cardiology? Because this nonsense came out right. And it evidently was nonsense.

[Dr. Mark Hyman]

So that's one of the top medical journals. So it's not like it's.

[Nick Norwitz]

Some happened with circulation too, with a report where they just basically lied through their teeth. And in both these instances, there is no actual good recourse. So they don't accept a letter to the editor. As I tried to do one for a circulation report, they said, it's a case report. You can't actually do an E letter. I emailed the journal, I emailed the first author. No responses. I even told the first author in an email on this JAMA Cardiology report. I said, this report seems deficient. If you have more details, I'm willing to help support you writing in the full case report as a cautionary tale. We want a detailed dietary record. If you want to get genetic testing, we can do it at my expense. I'm not against n equals 1. I'm not against cautionary tales. I'm not against case reports. I'm against intellectual dishonesty. And there is so much when it comes to meat and carnivore diets, and it just pervades the literature. I was reading a study in neurology about red meat and dementia, and they cited a study where they said saturated fat is bad because it lowers bdnf. And the study was a mouse study where the mice were fed an HFS diet, which stands for high fat sucrose diet.

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Yeah, I mean, that's the whole nother conversation, which is eating saturated fat in the context of a high sugar carb diet. That's what makes it deadly. And I read a lot about that in my book Food what the heck should I eat? I think people or even eat fat get thin. It's like it's not the saturated fat per se, it's when you combine it with the starch and sugar, which is mostly how it's found in our diet.

[Nick Norwitz]

Milkshake is not a steak. Again, relatively diet agnostic, but I do think there's a systemic bias in the media and the scientific literature against red meat and certainly carnivore diets, and I like to call that out.

[Dr. Mark Hyman]

So let's just say for some people with severe illnesses that a carnivore diet can be a therapeutic diet. I think the question I have is, is it the meat or is it what they're cutting out? And I, as a functional medicine practitioner, I'm leaning more towards it's what they're cutting out. They're not eating gluten, they're not eating dairy, they're not eating grains, they're not eating beans, they're not eating a lot of things that can irritate the gut. Is it the meat or is it just what they're not eating?

[Nick Norwitz]

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

[Dr. Mark Hyman]

Like you could add back things systematically. What I would also want to sort of double click on here is the narrative in the culture that meat is unhealthy, inherently bad. It's going to cause heart attacks, it's going to cause cancer. It's bad for you, we all know that it's bad for you. We're all told eat less meat, we're told eat less red meat. Where do we stand in 2025 on this data?

[Nick Norwitz]

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

[Dr. Mark Hyman]

So just to unpack that in English, people who, when they do these large population studies, the people who were eating meat at the time, and a lot of these studies were done in the 70s, 80s when meat was the boogeyman, the people who ate the meat were less healthy, they ate more, they drank more, they weighed more, they smoked more, they didn't take their Vitamins, they didn't eat the fruits and vegetables. It was a million reasons why they had more disease than the people who didn't. Conversely, those who didn't eat meat, we actually saw, you know, were healthier. But was it because they didn't eat meat or cause they were just healthier? They exercised, they didn't smoke, and so forth. We saw that with these large population studies like the Nurses Health Study, where it was assumed that women who took hormones were healthier across the board for brain health, heart attacks, et cetera. It turns out that wasn't true when we did a randomized controlled trial that was a billion dollars from the NIH called the Women's Health Initiative, where in fact, it showed many of the opposite findings because they actually did a proper study, not just look for correlation, which didn't prove causation. And that's what a lot of these nutritional studies are that people quote about meat being bad. They're population studies that don't take into account all these confounding factors that can make it seem like the meat's the problem, but it's really not.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

Instead, have a cauliflower, because we can take this nice sagittal section and make it look like a brain and, you know, feed into your base human emotions.

[Dr. Mark Hyman]

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

[Nick Norwitz]

No.

[Dr. Mark Hyman]

And that. And then metabolic health isn't broken by eating more meat. It's broken by eating more sugar and starch.

[Nick Norwitz]

By and large, yes.

[Dr. Mark Hyman]

That's kind of the bottom line here. And then what we're finding is that across a whole array of human diseases, we've been listing, again, from autism to Alzheimer's, from diabetes to depression, from cancer to colitis, there may be some common link here that we have missed. And this common link that you talked about is the root. And I think that's when you talk about metabolic health and when I talk about it, that's really what we're referring to, is we have a society where we have a massive metabolic health crisis. And it's not going to get fixed by limiting red meat or by eating more vegetables. I mean, it's going to be fixed by addressing the massive amounts of sugar and starch in our diet. And that's kind of the forest for the trees. We don't want to lose the forest for the trees.

[Nick Norwitz]

I agree. And to that extent, speaking about forests and plants, I just want to be very clear, me saying a carnivore diet can be beneficial for certain people. And red meat's not bad. Is not saying all fruit is terrible for you in all circumstances, fiber is bad for you. Like, these are consistent ideas. And I think people get so captured in one camp that there are presumptions based on unrelated statements. So red meat, not bad for you. Red meat can be a health food. Does it mean Brussels sprouts are poisoning you? Or broccoli is a conspiracy? No, it does not. You tolerate those foods. I think they're perfectly fine. And the fact. I'm quite jealous. I love Brussels sprouts. They just don't agree with me.

[Dr. Mark Hyman]

So, yeah. So, Nick, what is next on the frontier for you? Like, you're about to graduate Harvard Medical School. You've got your PhD. You know, what is the frontier in terms of your intellectual pursuits? That's next. And what's exciting for you, this will.

[Nick Norwitz]

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

[Dr. Mark Hyman]

You're right. I literally just read to what you're talking about. A woman, a wealthy woman and her family who Had a son, was bipolar, he cured himself through keto diet. They became very interested in this, created something called metabolic minds, which you mentioned.

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

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

[Nick Norwitz]

The Bouzouki family, they, they've been very nice to me and yeah, they're a great example of someone who, you know, I would never wish bipolar disorder on Matt Bouzouki, however, just like I'd never wish ulcerative colitis on me. But sometimes misfortune strikes the right group of people in order to build a highly motivated army to make change. And I think that's what's happening with metabolic health, and that's why I'm so optimistic, is because on the one hand, it's a David and Goliath scenario where big Pharma, the current medical infrastructure, biomedical infrastructure, like the incentive structure, business models are set up to favor pills and procedures and an unhealthy food environment. However, there is a growing group of people who are just finding incredible success with metabolic health approaches and then unionizing and coming together with, albeit, you know, individually, maybe fewer resources, a purpose that is so powerful. I can't imagine things don't change dramatically, but they're only going to do so if we really lean into it. And so that's what I'm committing myself to. It's not because I don't think western medicine has this place that I don't think it's important. It's that because over the past year or so, when I'm sitting in that intern room doing my intern level tasks, masks. It's not that I don't care about the patient, but my mind is not there. My mind is how can I communicate this incredible scientific story about nanotubes in the brain or cyanide being produced by our lysosomes or whatever to the general metabolic health is incredible thing. My mind just wasn't in the clinical medicine. And so I thought that wasn't fair for me, the patients or whatever member of my cohort, my peers would otherwise have that position in residency that I'm going to try doing something different because it's where my story, my skill set, my passion and my skills are most geared, where I genuinely think I can have the biggest impact and maybe I'll fall on my face, but I have to try.

[Dr. Mark Hyman]

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

[Nick Norwitz]

I like that.

[Dr. Mark Hyman]

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

[Nick Norwitz]

Thank you. I feel like I'm definitely standing on the shoulder of giants and just so excited for the future to come. One thing I will say that will hopefully bring listeners and you some more positive vibes, let's say, is like, I've been feeling out just kind of naturally the interest in metabolic health among my generation of future healthcare leaders. And it's incredible. It's like people see, my peers see our system is screwed up, medicine has changed for the worse, that patients are suffering and we are not stepping up as a system to help them enough, and they're looking for innovative solutions.

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

And so I found my peers to be so receptive to the metabolic health message. Actually, I was so concerned about this that before I started at Harvard, I wrote a piece for Stat News that was will the ketogenic diet make me a pariah in medical school? And what I found to be the case is, behind closed doors, people are so open to these fascinating innovations in metabolic health.

[Dr. Mark Hyman]

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

[Nick Norwitz]

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

[Dr. Mark Hyman]

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

[Nick Norwitz]

Well, it's difficult because it's like, I know exactly what I'm doing when I eat Oreo cookies to lower my cholesterol. I know the media is going to run with it and say, harvard doctor, Harvard scientist, lowers his cholesterol with Oreo cookies. And I know that's going to create confusion. I also know that the simpler thing is going to happen when I do 720 eggs, or that it's kind of clickbaity for me to do debunked with my picture next to a giant ribeye steak when I'm debunking eight carnivore myths. That said, I don't really see another way to access people unless you provide them engagement bait that then draws them to the table to have nuanced discussions. They're using Oreo cookie as a case in point.

[Dr. Mark Hyman]

Okay. You're just dangling a little, like bait on the hook.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Gonna be haters and there's gonna be lovers, and it doesn't matter who you are, what you say. It's always that way. It's always been that way. And you could. You could. You just kind of have to let it roll off your back.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Oh, you mean you were coming out against it, saying that there's harm?

[Nick Norwitz]

I think there is. I will probably never drink a Diet Coke again.

[Dr. Mark Hyman]

Well, give us this. We're about to close, but I want to hear the snapshot because, you know, for example, Lane Norton, who's well respected nutrition scientist who certainly has a following, he basically says all the data about artificial sweeteners is garbage. Now, when I looked at some of the papers that he was citing, it was funded by the American Beverage association, otherwise known as the American Soda Pop association before it changed its name. I'm like, I'm not sure about this. So what's your thumbnail perspective on artificial sweeteners? Give us the down and dirty.

[Nick Norwitz]

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

[Dr. Mark Hyman]

Well, well, you could say you're eating less calories. Is there a way to lose weight?

[Nick Norwitz]

You're not eating less calories though, unless you have the binary of it's a Coke or a Diet Coke. And I hate that binary. People are like, is it worse than a Coke? I'm like, why are you choosing between these two things?

[Dr. Mark Hyman]

Right?

[Nick Norwitz]

Like if that is actually your binary.

[Dr. Mark Hyman]

Like arsenic or strychnine, then you can.

[Nick Norwitz]

Choose the lesser of two evils. That is a legitimate choice. And my thing is not to say people shouldn't have Diet Coke. It is. Here are the data. Make an informed decision like a freaking adult if you want to slam Oreo cookies and eat milkshake.

[Dr. Mark Hyman]

What is the data? What is the data?

[Nick Norwitz]

So what I would say is there are really interesting data showing potential high impact harms like transgenerationally inheritable anxiety. So there's a paper in pnas, ironic because it sounds like penis, but it was, it was an animal model paper, mice. And I'll explain why that is totally legitimate in a moment. But where they fed mice the equivalent of two to four Diet Cokes for humans in aspartame. Not only did it generate anxiety on behaviorally validated tests, but it was a transgenerational effect. So the offspring of the mice and even the grand offspring.

[Dr. Mark Hyman]

So epigenetics.

[Nick Norwitz]

Yeah, presumably. So past. In this case, we're looking at the male lineage, but there was anxiety in the offspring and the grand offspring, even though they'd never been exposed to low dose aspartame because their fathers and grandfathers had been exposed. So, you know, and, and there's, you know, physiological explanations for how this might work, how aspartame also might affect brain health, how it's breaking down, how it changes amino acid transport to the brain. We can get all that and also human data on, quote, say irritability, including randomized controlled trials. So there's some signal in the human literature for sure. It's not the most rigorous of all time study, but then very concerning things in the preclinical literature. And the thing that people tend to do, the Diet Coke defenders, like Perverse Avengers or something, they tend to do is they put up a very implausible bar of evidence. So let's take the example of this study, this PNAS study. What it's saying is in Mammals, low dose aspartame, the equivalent to what the FDA says is totally fine. It's like 7 to 15%. What the FDA says is okay, 2 to 48 ounce Diet Cokes can cause anxiety that is transgenerationally inheritable. You can ask, well, oh, prove this in humans. I'm like, you're really going to try to do a 50 to 60 year randomized control trial where you give human adults Diet Coke and then track. It's never going to be done. And so you're asking for evidence that that can't be collected. And I'm not saying the evidence is entirely watertight. So another paper just came out and I think it was cell metabolism on aspartame and cardiovascular disease. And what they showed in mice, and also they had some monkey data, was that it can spike glucose and insulin. And what this did was increase plaque progression in susceptible mice, admittedly susceptible mice. However, the mechanism had to do with increasing certain molecules on the endothelial lining. Basically there were like baseball gloves for rolling around immune cells, which is the baseball that sucked them into the arterial lining and caused plaque to grow. So there is a very clear physiological model with data in mice and primates showing how this could negatively impact heart health in conjunction with associational data saying artificial sweetener intake is associated with cardiovascular disease. Does this prove beyond a shadow of a doubt that diet co star disease? No, but you shouldn't need those data to incorporate the existing literature, which is of concern into your individual algorithm of whether or not you want to make the decision. So. And artificial sweeteners, to be clear, in humans have been shown to cause insulin resistance. Sometimes it takes longer than a day or so. There was one study out of Weinsman Institute, I think it was in nature, where they showed that it was saccharin, in this case caused insulin resistance by changing the microbiome. In this case it was a majority. But not all people had a response. There might be individualistic elements. It may take time to result. The data are not absolutely proven without a shadow of a doubt. But there's enough there to say this is concerning.

[Dr. Mark Hyman]

And then there's a cautionary principle.

[Nick Norwitz]

Where do you put the burden of proof? Yeah, is the burden of proof defined the implausible study that proves it without a shadow of a doubt, or can you just say, you know, these literature are concerning enough for me to be like, I might be okay with freaking water.

[Dr. Mark Hyman]

Well, do you think to speak to that? I mean, with this sort of new administration and the desire to sort of take chemicals Out. Do you think that should be a target? Because right now it's kind of considered a grass substance. It's generally recognized as safe. The FDA doesn't really regulate it other than saying food companies, well, do you think it's safe? They go, yeah, we think it's safe. And they, okay, if it's safe, well, we can have it. And there it goes in the marketplace. That's kind of how we do it with chemicals in our food supply until we find out their problem.

[Nick Norwitz]

It's funny because this, you actually hit on a broader point about, about this burden of proof. Because if you don't have evidence to say this is very harmful and sometimes the harms manifest over a long period of time, then should you be allowed to introduce a substance into the food supply? And the fact of the matter is, right now, the way it is, the answer is you are allowed. You are allowed. And then after the fact, we might.

[Dr. Mark Hyman]

Do the first, ask questions later.

[Nick Norwitz]

Right, but. And so, so let's say just playing with random numbers here, there's only a 1 in 100 chance that any given chemical actually that is not proven to be safe over a long period of time is harmful. Well, if you introduce 10,000 chemicals and.

[Dr. Mark Hyman]

They'Re all, Are they all synergistic?

[Nick Norwitz]

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

[Dr. Mark Hyman]

I think when I was in South America, I was so shocked to see on the diet soda can.

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

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

[Nick Norwitz]

Yeah.

[Dr. Mark Hyman]

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

[Nick Norwitz]

Have you seen some of the coffees at Starbucks?

[Dr. Mark Hyman]

Well, no, no, no. Personally, you're not gonna sit at teaspoons of sugar, but you will get it. When you have processed foods like a 20 ounce soda or Starbucks coffee, you'll easily get that.

[Nick Norwitz]

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

[Dr. Mark Hyman]

I'll put out and make anxious sperm. So don't do it.

[Nick Norwitz]

I know it's. Yeah, anxious sperm. Is it worth it to you to risk a potential impact on the mental health of your future children, which you'll never know for sure? Say they develop anxiety. You'll never know if it was your fault or not. You will never know. But is it worth it to you to have those two Diet Cokes per day? Is it?

[Dr. Mark Hyman]

Yeah.

[Nick Norwitz]

And I would say it's just like for me, no. If it really matters to you that much. You're an individual, you can make an adult decisions. Your kid's not mine.

[Dr. Mark Hyman]

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

[Nick Norwitz]

It's my first tattoo.

[Dr. Mark Hyman]

I love that.

[Nick Norwitz]

My karate sensei and I got matching stay curious tattoos. I love that person only.

[Dr. Mark Hyman]

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

[Nick Norwitz]

It's not my health recommendation.

[Dr. Mark Hyman]

No, no, no. So anyway, great, great. Really great. Great to talk to you about all this stuff. I feel like I literally. I could talk to you for another 10 hours and we wouldn't even get to the bottom of it. So perhaps. Well, once you graduate from medical school and figure out what's next on your horizon, we'll have you back. And, Nick, keep up the good work and stay curious.

[Nick Norwitz]

Thank you so much, Mark. Stay curious.

[Dr. Mark Hyman]

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[Dr. Mark Hyman]

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[Unknown]

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[Dr. Mark Hyman]

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[Dr. Mark Hyman]

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[Unknown]

You love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center, my work at Cleveland Clinic, and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.