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Nick Norwitz MD PhD Profile picture
@nicknorwitz
Apr 5, 2021 • 6 tweets • 4 min read • Read on X
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Prepare for a thread about Well-formulated #Keto Adherence Paper that just came out.

Randomized crossover trial of 2x12-week #keto #LCHF vs. #Mediterranean diet.

Results show equally sustainable given the right conditions, but...
Researchers designed study that during first 4 weeks of each diet, food was provided & during the next 8 they had to buy their own. Baseline&followup adherence scores were also collected. All this allowed researchers to determine how sustainable diets were under diff conditions
baseline #keto adherence score was lower than Medi score. BUT during the time period when food was provided AND when they had to buy their own food, mean keto score was equal to or higher than Medi score. At the follow-up #keto score had dropped again. From this I conclude...
keto diet was not hard to adhere to itself, but social enviornment pushed ppl away from it b4&after study
In other words, not a diet issue but a social acceptability issue (at the population level)

Can see no difference (or a slight edge to keto) when food was made available.
Was also interesting to see some reasons individuals prefered one option over the other. IMO "better glucose numbers" is a better reason than "keto is for weight loss" / "I had no energy" (discouraged mineral supp during adapation), bc the latter 2 are misconceptions/misleading
Overall good study&both diets were strong-ish. Both <40% CHO reduced refined grains/ simple sugars. Chronometer was used to track food intake & ketone blood meters confirmed nutritional ketosis.

In Sum, keto is not a hard diet to which to adhere. It's our darn food ecosystem :(

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More from @nicknorwitz

Nick Norwitz MD PhD Profile picture
Apr 30
The Peptide Proven to Cut Visceral Fat (In RCTs) 🧵

1/6) There is a peptide proven in multiple double-blinded, placebo-controlled randomized controlled trials to reduce visceral fat.

It’s called tesamorelin. (link at the end)Image
2/6) Tesamorelin is an analog of growth hormone–releasing hormone, a hormone released by the brain that signals the pituitary to release growth hormone.

Its main advantage over growth hormone is that it stimulates the body’s natural release of growth hormone, rather than adding a non-physiologic dose that doesn’t align with biological rhythms.Image
3/6) To give you just a taste of data: in a landmark 2007 New England Journal of Medicine study, patients with HIV on antiretroviral therapy and excess abdominal fat were given 2 mg of tesamorelin or placebo for 26 weeks.

Visceral fat decreased by ~15% in the tesamorelin group, while it increased in the placebo group. Subcutaneous fat did not change, and there was no loss in lean mass.

*Nuance note: Historically, the patient population studied has been patients with HIV taking antiretroviral therapy. Why? These therapies can cause visceral fat gain. So these patients aren’t biologically unique to HIV—they’re just a particularly vulnerable population in which these drugs have been assessed and FDA-approved.Image
Read 6 tweets
Nick Norwitz MD PhD Profile picture
Apr 28
After 7 Years, I Changed My Mind on Cholesterol Meds (Or Did I?)

🚨You'll want to read this one all the way though. Link at the end🚨

1/7) After seven years of living with astronomically high cholesterol, I’ve decided to start two medications. Not statins, but ezetimibe and bempedoic acid.

But that’s NOT the real story. The real story is WHY… and it has nothing to do with cholesterol🤨🤔...

Quick preface: “cholesterol-lowering drugs” are named for one effect, not their full biological impact.

Molecules don’t respect our labels. These drugs can influence multiple systems, including metabolism and brain health.

And in this case, they likely do.Image
Image
2/7) Take ezetimibe. Beyond lowering LDL, evidence suggests it crosses into the brain and influences neurobiology.

Specifically, is disrupts the interaction between 14-3-3 and hexokinase, reducing protein aggregation.

Full video:
3/7) That means less amyloid, less tau, and even improved autophagy.

Even more interesting: retrospective analyses have found up to an ~8x lower risk of Alzheimer’s in patients on ezetimibe.

Not causal. Not definitive. But a signal worth paying attention to—especially in the right context.Image
Read 7 tweets
Nick Norwitz MD PhD Profile picture
Apr 25
1/5) Here are four things statins do in your body.

First: A human controlled trial found statins reduced GLP-1 levels by 50% in 16 weeks.

The clinical implications aren’t fully clear—but the fact this isn’t discussed is a disservice to science and to patients. Image
2/5) Statins disrupt mitochondrial function.

They reduce CoQ10 synthesis (a key electron carrier) and directly inhibit Complex IV in the electron transport chain. These are biochemical effects—but they matter for informed decisions.
staycuriousmetabolism.substack.com/p/the-mitochon…Image
3/5) Statins are sexist. Women face higher risk of muscle pain, potential muscle loss, and statin-induced diabetes.

Why? An extra X chromosome—and a gene affecting fatty acid (DHA) synthesis. Less DHA → worse mitochondrial function + higher blood sugar.
staycuriousmetabolism.substack.com/p/the-x-factor…Image
Read 5 tweets
Nick Norwitz MD PhD Profile picture
Apr 18
If you're worried about Alzheimer's disease, you need to know this about Omega-3s 👇

1/8) If you want to avoid Alzheimer’s, you need to understand these critical facts about fat metabolism in the brain.

Let’s start with this graph.

It shows how biomarkers change over the course of developing Alzheimer’s—from normal cognition, to mild cognitive impairment, to full-blown dementia.

The first thing to decline is lipid metabolism. But here’s the good news: that decline may be preventable. (link at the end)Image
2/8) The most important fat for the brain is DHA, a long-chain omega-3 fatty acid.

DHA makes up around 40% of the fatty acids in the gray matter of your brain.

It supports neural structure, reduces inflammation, improves brain glucose metabolism, and even helps clear metabolic waste like amyloid.Image
3/8) Now here’s where genetics becomes crucial. 25% of people carry ApoE4, the main genetic risk gene variant for Alzheimer’s.

ApoE4 codes for an altered form of an apolipoprotein, which impacts lipid metabolism, especially DHA metabolism. Image
Read 8 tweets
Nick Norwitz MD PhD Profile picture
Apr 7
Eating 1000 Sardines Gave Me THIS Superpower
(New 2026 Findings!)

1/8) I ran a self-experiment where I ate 1000 sardines in a month.

Sure, it made me stink—but it also gave me one epic superpower. Let me explain. 🧵 (link at the end)

We all know sardines make your breath stink and that they’re nutrient-dense.

That’s basic.

But eating that many sardines changed me. It gave me a “superpower” that had my inner Marvel nerd activated—and my scientist brain scrambling to explain it.

Eventually, I found those data.Image
2/8) It was new paper in a top journal turned confusion into clarity and left me in awe of how much we’re still uncovering about human physiology.

The superpower…

Full deep dive link: staycuriousmetabolism.substack.com/p/why-stinking…Image
3/8) I became cold resistant. The effect wasn’t subtle. I could stand shirtless in a Boston blizzard without so much as a goosebump. Image
Read 8 tweets
Nick Norwitz MD PhD Profile picture
Apr 4
Citrus Bergamot for Cardiovascular Health

1/5) One meta-analysis of controlled human trials found that citrus bergamot extract lowers triglycerides, increases HDL, and lowers LDL — to a substantial degree.

But that’s not all... (link at the end) Image
2/5) More interestingly, one trial showed that while bergamot decreased small dense LDL, it increased‘large, fluffy’ LDL.

This shift towards a preponderance of large LDL vs small LDL is a metabolic fingerprint of improved metabolic health. Image
3/5) So how does citrus bergamot work?

Citrus bergamot isn’t a single nutrient — it’s a cocktail of polyphenolic compounds that influence multiple metabolic enzymes.

For example, the bergamot polyphenols inhibit the enzyme ACAT, contributing to downstream increase LDL receptor expression.Image
Read 5 tweets

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