Public Apology Thread
1/ A couple days ago I posted a tweet that I intended to be a commentary on the state of diabetes management in the US. What I didn’t realize at the time is that the image had a lot of historical baggage and suggested a patient-blaming perspective...
2/ Maybe I should have been aware of this history or maybe it’s irrelevant. I’m not asking for forgiveness for that ignorance. The point is that it seriously offended some people. In the hours during which the Tweet is up, before I gathered how it was really hurting people...
3/ and took it down, I doubled down on it in responses. The blunt truth was that I was resistant to listening because I got caught in the heat of aggressive comments, including a few violent threats. Excuses aside, I’m sorry to anyone I hurt. The LAST thing...
4/ in the world I’d ever want to do is blame a patient. You might not all know my history, but I’ve felt that sting and there is nothing worse. To imagine that, even unintentionally and in ignorance, I brought that sort of pain to people makes me cringe.
-And a special thanks to Dr. @cadiulus for being so generous with her time in discussing this issue with me and affording me greater inisght.

With gratitude and empathy for the patient-blamed (if you could possibly believe it), Nick

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More from @nicknorwitz

5 Apr
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...
Read 6 tweets
26 Feb
nature.com/articles/s4159…
Some thoughts on why these results don't mean much to me
1/ It was 2 weeks, which is short term and not enough time for adaptation (see point 8 and others on this)

2/ "Both diets were low in ultra-processed food" is a misrepresentation....
...the low-carb diet was, IMO, unfairly weighted by processed foods and oils including mayo that I assume was made with soybean oil (correct me if I'm wrong), processed cheeses like "American cheese", and so on. It was also weighted towards meats and A1 dairy
3/LC diet appears far more palatable, and both diets were designed by the investigators, not freely chosen by the participants. If my snack options were unlimited roasted salted nuts sitting in front of me or dry edamame, apricots, and raisins, I'd eat more kCal of nuts too.
Read 8 tweets
23 Feb
Colleague and I had this RCT thrown in our face bc suggested a #ketogenicdiet option. Arguement was this RCT shows LCHF ⬆️LDL, therefore bad. Here's a thread about what I think...
(Spoiler, LCHF = good)...
1/ The LDL increase in the LCHF group may not itself be an adverse outcome. There was no subfractionation and it’s likely the increase in LDL and ApoB was driven by large fluffy healthy LDL particles. This assumption is supported an improvement in HDL levels in the LCHF group.
2/ HDL increased on the LCHF group, not the control group. When HDL is high and triglycerides are low, CVD risk is not meaningfully increased. See figure attached from Framingham. Furthermore, HDL (and waist circumference, below) are markers of metabolic syndrome. LDL is not.
Read 6 tweets
13 Dec 20
Today's FoD is being substitued by a thread of quotes from the below article
Explains how, in 1965, The Sugar Research Foundation (SRF)/Sugar Industry bought off scientists to promote sugar+demonize fats.
ncbi.nlm.nih.gov/pmc/articles/P…
A Must read
Cred to .@ProfTimNoakes lecture
The Sugar Research Foundation (SRF) became concerned with evidence showing that a low-fat [high-carb] diet high in sugar could elevate serum cholesterol level…
The SRF’s vice president and director of research, John Hickson, started closely monitoring the field…
Hickson proposed that the SRF “could embark on a major program” to counter “negative attitudes toward sugar.” …
In 1965, the SRF asked Fredrick Stare, chair of the Harvard University School of Public Health Nutrition Department to join its SRFs scientific advisory board
Read 11 tweets

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