Nick Norwitz Profile picture
Nov 11 4 tweets 2 min read
1/4) I want to unpack this quote from our #LMHR editorial

Operative word="CONSIDER"

LMHR are understudied, w/ nothing proven about 🫀 risk in this population

Thus all patients should consider available data IN THE CONTEXT of their n=1 medical situation
2/4) We are NOT making a blanket medical recommendation; we are doing the opposite!

We advocate that all parties - patient, doctors, and scientists - maintain an open mind on what is clearly on open, controversial, and critical issue
3/4) This is not only the right thing to do, but it is the quickest way to progress

Open mindedness is a matter of reciprocity

Being dogmatic in either direction while data are outstanding, stalls progress
4/4) Finally, it's important to recognize that all physicians, scientists, and communicators can do is provide information

The choice is and should belong to the patient.

- Nick out (for now...)

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More from @nicknorwitz

Nov 8
1/ Highlighting the strawman &loose associations bw diet &othr beliefs is a standard tactic 2 get clicks and rile the base

But you'd think this fellow would have insight not to TW this fluff directly after we published an editorial refuting his claims
sciencedirect.com/science/articl… Image
2/ I don't have an issue if one wants to make a counterpoint to a direct claim

But all he's doing by pulling out the broad brush and capitalizing on stereotypes is exacerbating pre-existing polarizations and thus undermining efforts to engage in productive & educational dialogue
3/ Also pitiful when a medical "professional" feels the need to make himself a joke and brand-build by consistently targeting a dietary pattern

Might the evidently many hours spent teasing others be better spent on trying to write something productive?

...Maybe an editorial? ImageImageImageImage
Read 4 tweets
Nov 6
🚨 NEW! Lean Mass Hyper-Responder Editorial🚨

👉 10 MD & PhD authors from 4 countries🌍coming together for 1st of it's kind Consensus Statement on #LMHR

👉 Published in official Journal of the National Lipid Association @LipidJournal

A thread 🧵👇
authors.elsevier.com/a/1g22A6tb2E2O…
2/ A bit of background to catch some of you up

Over the past 6 years a population of people has emerged who demonstrate ⬆️ LDL on a #ketogenic diet in the context of ⬇️TG +⬆️HDL

Phenotype was first observed by @realDaveFeldman and (historically) named Lean Mass Hyper-Responders
3/ 1 year ago, we started researching #LMHR more formally, and in this year, we've published 4 prior papers

Cohort Study
pubmed.ncbi.nlm.nih.gov/35106434/
Case Report
pubmed.ncbi.nlm.nih.gov/35498420/
Cholesterol drop protocol
pubmed.ncbi.nlm.nih.gov/35938774/
Lipid Energy Model
pubmed.ncbi.nlm.nih.gov/35629964/
Read 11 tweets
Sep 24
1/ This is true, but for those who are interested deserves some unpacking. Short thread… Here we go…

Yes, insulin resistance is a stronger risk marker than elevated LDL-C. This can be quantified as lipoprotein insulin resistance (LP-IR).
2/ in the largest prospective trial to date (WHS, median follow-up was 21.4 years. N=28 024 women aged >45 years). LP-IR had an adjusted hazards ratio of 6.4 for coronary disease, as compared to 4.3 for obesity 3.9 for smoking and only 1.3 for LDL-C.

jamanetwork.com/journals/jamac…
3/ in other words, there was ~ 540% increase in coronary disease risk with insulin resistance but only ~30-40% for LDL-C. Furthermore, there was likely an interaction between terms as the association didn’t hold for large LDL but was driven by small LDL, which is associated w/ IR
Read 17 tweets
Sep 11
Are you more knowledgeable that a Nutritionist?!

Doing a nutrition/metabolism knowledge survey of healthcare trainees.

Piloted these 10Q on 5 different nutritionists. Highest score was 70%!

Let’s see how YOU do…
1/ Gluten is which of the following macronutrients?
2/ Which of the following foods has the lowest proportion of fat as monounsaturated fat?
Read 14 tweets
Aug 21
1/ Have you seen the New Non-Nutritive sweeteners paper in Cell making the rounds!?! Fantastic!

Here's a video rundown:

And this thread contains a brief tweetorial...
2/ This study took 120 young health people who didn't consume non-nutritive sweeteners (NNS) and broke them into 6 groups, n = 20/group
👉 Control (no supplement)
👉 Glucose
👉 Sacchrin
👉 Sucralose
👉 Aspartame
👉 Stevia
7 day baseline, 14 day exposure, and 7 day follow-up
3/ There was a clear individualized response across NNS, with Sucralose and Saccharin having the largest impact on glucose tolerance on oral glucose tolerance test.

There were "responders" (who had worse glucose tolerance in response to NNS) and also non-responders.
Read 11 tweets
Aug 15
🚨NEW PAPER! CGM for Med Students🚨

We provided @harvardmed students w @dexcom CGM

Students reported

👉Improved appreciation for metabolic health

👉Wearing CGM will help them better serve patients

👉Disappointed in standard dietary advice

Cont ⬇️
journals.sagepub.com/eprint/CXUGZCT… Image
2/ The story behind this study started back in the fall, when a grass-roots group of my peers expressed interest in designing a "Metabolic Health Immersion" program to help us learn about how lifestyle impacts metabolism and health... Image
3/ 40 students wore CGM for 10-40 days, and a subgroup also engaged in journal clubs, patient panels, dietary tracking, and took intake and completion questionnaires with qualitative and quantitative components 👇 Image
Read 9 tweets

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