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Nick Norwitz MD PhD

@nicknorwitz

May 16

The Heart Supplements I Recommend to Family 🧵 👇

1/7) I have astronomically high cholesterol (>700 mg/dl) and high Lp(a) (194), but my arteries are perfectly clear. I mean perfect! 0 mm³ of any measurable plaque upon expert read and AI-guided quantification of my coronary CT angiogram—a finding that left several cardiologists stunned.

2/7) And although I'm young, at levels like mine, this is still stunning. The only historical comparator group are those with a 1-in-1,000,000 genetic condition: homozygous familial hypercholesterolemia (hoFH). Now, I don't have this hoFH. These children typically get severe advanced atherosclerosis and even a heart attack as young as age 8 or 10.

In fact, I have far more lifetime exposure than these children, yet my arteries could not be more perfect.

3/7) I'm not going to chalk up my good cardiovascular health to any supplement one singular aspect of my health routine. Nothing beats being overall metabolically healthy and eating and living well.

Nevertheless, my personal story has inspired a curiosity in readily available natural compounds that can improve heart health. Today's deep dive letter is a result of my obsessive fascination in heart health—a synthesis of tens of thousands of written words and hundreds of papers that I've gobbled up over time.

Let me give you a taste…

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Nick Norwitz MD PhD

@nicknorwitz

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)

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.

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.

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Nick Norwitz MD PhD

@nicknorwitz

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.

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.

Read 7 tweets

Nick Norwitz MD PhD

@nicknorwitz

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.

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…

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…

Read 5 tweets

Nick Norwitz MD PhD

@nicknorwitz

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)

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.

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.

Read 8 tweets

Nick Norwitz MD PhD

@nicknorwitz

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.

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…

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.

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More from @nicknorwitz

Nick Norwitz MD PhD

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Nick Norwitz MD PhD

Nick Norwitz MD PhD

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