24. Dr. Nick Norwitz: Harvard Doc Tells How He Cured Himself When Standard Medicine Failed

In this episode, we sit down with Dr.  Nick Norwitz, who is, in his own words, a researcher educator whose mission is to make metabolic health mainstream. Dr. Norwitz has a PhD in human metabolism from Oxford University and is about to get an MD from Harvard Medical School. We are interested here in his own story of healing chronic illness, in which modern standard medicine absolutely failed him and forced him to find his own path back to health. And this sheds a lot of light on the value of individualizing metabolic health care. And in fact, his story illustrates the n of 1 model of health care, which can often be the only way to work out the best diet or best therapy for whatever ails us and which I believe is the future of medicine.

Doctor Norwitz also shares his insights about the process of human change and just exactly what motivated him when he knew he needed to make changes for his own survival. Join us as we chat with the very doctor Norwitz, and be sure to check out the show notes for links to all of his social media appearances. These are not only brilliant but highly entertaining.

Here are links to just a few of his many ventures:
https://www.youtube.com/@nicknorwitzPhD

on X: https://x.com/nicknorwitz

Instagram: https://www.instagram.com/nicknorwitz/ 

and for links to all his publications and writings, visit his website @ 

https://www.nicknorwitz.com/

Dawn Lemanne, MD
Oregon Integrative Oncology
Leave no stone unturned.

Deborah Gordon, MD
Northwest Wellness and Memory Center
Building Healthy Brains

Transcript

Intro:  Dr. Nick Norwitz          The scientific method isn't that complicated.  You identify an outcome measure you care about. You hypothesize what might change that outcome measure. You implement an intervention in line with that hypothesis, and then you assess the data with curiosity, and then you iterate. So you can do this as an individual very simply, and your data can be things like, you know, body composition, could be hormones.

It could just be your subjective feeling. It could be kind of anything. But the power of n equals 1, I think, is twofold. 1, that kind of application I just talked about using, you know, new technology that's arising. And 2, to empower every individual now to be at the helm of their own, you know, health journey, their own metabolic health ship, if you were.

[00:00:48.040] – Dr. Lemanne
You have found your way to the Lemanne Gordon Podcast where docs talk shop. Happy eavesdropping. I'm Doctor Dawn Lemanne. I treat cancer patients.

[00:01:06.720] – Dr. Gordon
I'm Doctor Deborah Gordon. I work with aging patients.

[00:01:10.550] - Dr. Lemanne
We've been in practice a long time.

[00:01:13.030] - Dr. Gordon
A very long time.

[00:01:14.550] - Dr. Lemanne
We learn so much talking to each other.

[00:01:16.710] – Dr. Gordon
We do. What if we'd let people listen in?

 [00:01:25.990] - Dr. Lemanne
In this episode, we sit down with Doctor Nick Norwitz, who is, in his own words, a researcher educator whose mission is to make metabolic health mainstream. Doctor Norwitz has a PhD in human metabolism from Oxford University and is about to get an MD from Harvard Medical School. We are interested here in his own story of healing chronic illness, in which modern standard medicine absolutely failed him and forced him to find his own path back to health. And this sheds a lot of light on the value of individualizing metabolic health care. And in fact, his story illustrates the n of 1 model of health care, which can often be the only way to work out the best diet or best therapy for whatever ails us and which I believe is the future of medicine.

 Doctor Norwitz also shares his insights about the process of human change and just exactly what motivated him when he knew he needed to make changes for his own survival. Join us as we chat with Doctor Norwitz, and be sure to check out the show notes for links to all of his social media appearances. These are not only brilliant but highly entertaining.

[00:02:51.800] - Dr. Gordon
I'm a family doc who hasn't done conventional family practice since, 1985. That sort of gives you a little insight into how old I am, but I was old when I went to medical school, so don't try and do the math. But I've been doing alternative medicine, integrative medicine, and most recently, precision medicine with Doctor Bredesen, with neurocognitive. We did that 1 research project I sent to you, and I'm still seeing patients doing that.

[00:03:20.870] - Dr. Lemanne
\And I do standard oncology. I my practice is called integrative, oncology, but I use standard treatments. And I augment them with, keto diet, fasting, certain types of exercise, sauna cold plunge, etcetera, metabolic things. So I'm really I've really been following your career and, Internet presence with great interest and and, gratefulness, for the young generation. Tell us your superhero story.

[00:03:48.590] - Dr. Lemanne
Yeah. Yeah. You've got a great one, and so our audience can can, learn a little bit about you and where you're coming from.

[00:03:53.820] - Nick Norwitz
Sure. I've, I've never heard it framed as a superhero story, but I kinda like that.

[00:03:57.260] - Dr. Lemanne
Yeah. Yeah.

 [00:03:58.700] - Nick Norwitz
My, you know, background was I always wanted to be a scientist and a doctor. I grew up in a a medical and scientific household. Both my parents are MD PhDs, and it's always just what I envisioned for myself. And it was always very complimentary, at least I thought, to my skill set. I was always very interested in biology, very curious.

[00:04:19.690] - Nick Norwitz
You know? Just go about the world, exploring it through the lens of, well, biology. Like, I go and see a dead snake in the forest, and there'd be a lump in his stomach. I'm like, I need to figure out what this lump is. Bear in mind, at this point, I'm, like, 5 years old.

 [00:04:35.760] - Nick Norwitz
So I'm, like, can snakes get pregnant like that? And, also, if they can, where's the snake's penis? Which is a question I could ask at 5 years old because my dad's an OB GYN, and my mom's a psychiatrist. So we had those conversations early. But throughout my my life, like, I was just so interested in biology.

 [00:04:53.600] - Nick Norwitz
Like, even in middle school, I'd be, like, reading biology textbooks for fun. And that's not a joke. That's just how I was.

 [00:05:00.320] - Dr. Gordon
I believe it. I believe it. Yeah.

 [00:05:03.790] - Nick Norwitz
So so going into high school and then in college, it was always something that I was geared towards, and I always imagined myself going down the standard path. Medical school, maybe with some research background if I had the opportunity, which I ended up getting after college. I got a scholarship to go to Oxford in my PhD. So I did that in human metabolism, and then I, came back across the pond from England to back to the Boston area to do medical school at Harvard. But along the way, at the end of college and then in in, grad school when I was doing my PhD, I had the, unluck, you could say, to be struck with my own metabolic condition, which was for me inflammatory bowel disease, specifically ulcerative colitis, which, you know, really upended my life.

 [00:05:50.800] - Nick Norwitz
I went from being someone who was, very engaged socially, academically, always at the top of my class, very engaged athletically. Like, when I was 17, 18, I was running sub 3 marathons, you know, doing push up competitions. Like, I was a high performer, in every respect, but that, the ulcerative colitis really took everything from me. I I lost a ton of weight and muscle mass, all my energy. I became very, like, physically fragile.

Mentally, I just wasn't there. I had this, like, brain fog that was consistent. I was in and out of the hospital, including intensive care, and my social life also kind of crumpled. It's pretty hard to engage with your friends if you have to worry about, you know, bloody diarrhea at a moment's notice. And the idea of a romantic life went out the window with that as well.

You can imagine that's not conducive to to dating. At this point, I was in my early twenties, 22, 23. So in the the time frame of a couple of years, I really lost a lot, and there was this funny juxtaposition of, like, on paper, everything just seemed teed up for me. Like, I got a scholarship to do my PhD in England, then I had a place at Harvard Medical School. And, like, I had checked all the boxes.
 
[00:07:10.730] - Nick Norwitz
But if you met me in person, you could just see, like, I just was not a full human being. I was in and out of the hospital, doggy paddling, just trying to stay afloat with the studies that I had committed to. So throughout all this, I'm I'm trying conventional treatments, and, none of them are having the the effect that I would really want. And that's, you know, to no fault of my medical teams. I had some really fantastic caring physicians, but they just weren't working for me for whatever reason.

 [00:07:42.600] - Dr. Lemanne
Could you list just a couple of the treatments that you had?

[00:07:46.440] - Nick Norwitz
Yeah. I had tried some biologics, so immunomodulating drugs. So standard frontline therapy like Mesalamine for ulcerative colitis, steroids on occasion, but they wouldn't keep me in remission. Sometimes I had weird responses to drugs. For example, with the colitis I had, it was left-sided colitis with a cecal patch and some proctitis. When you're not in a flare, having bloody diarrhea 20 times a day, sometimes the pendulum swings to the other end of the spectrum, and you can have IBS with constipation, which is difficult in its own way. I remember one time I was in the UK, I tried a drug to help with that. For whatever reason, my sphincters went into spasm, and I spent 24 hours just convulsing on the floor because I was having peristaltic contractions with my sphincters closed, which is very uncomfortable. That was after I had moved to Oxford recently. I'm sitting there, young 20s, on the floor of my dorm room without really knowing anybody, just waiting for the pain to dissipate after an unfortunate drug trial. It was a reasonable thing to try, but these things were just not working. I was losing hope. 

 And, you know, anybody who's had a loved 1, or cared for someone who is, you know, at that level, you get desperate. And you start trying things, not because you expect them to work, but because you're like, what do I have to lose?  

And so that's what I did. And, so I had probably a pretty diminutive view of, like, nutrition sciences. I was kind of, like, in that headspace that I think a lot of people are where you're like, I know what healthy is. Like, eat a balanced diet. Like, get your 5 a day. How much impact could it have? Nevertheless, kinda made sense. You have bowel disease. You tried toggling diet. So I tried a bunch of different diets.

 Every diet, you can imagine starting with the conventional ones for for IBD and IBS. So, low FODMAP, specific carbohydrate didn't really help, but also, you know, standard healthy eating or what's perceived as healthy eating, you know, Mediterranean and vegetarian, all that didn't really help. But, eventually, I tried a ketogenic diet. 

[00:10:01.060] - Dr. Lemanne
How did you come across that diet?

[00:10:03.460] - Nick Norwitz

Well, it was in the zeitgeist. I had  a family member who had gone low carb for weight loss. It was you know, that was definitely not my goal at that time, because I had lost so much weight. But, nevertheless, it was on my radar as, like, a thing to try. And I was aware of some preclinical data, not clinical trials.

There still are no, like, randomized trials for something like IBD. But there was like, alright. There might be some biological possibility here. And, again, you're in a headspace of desperation when you're like, alright. What's the worst thing that could happen?

I don't have fudge and bread for a couple of days. Actually, I live next to a fudge store in Oxford, which I frequented. And, and maybe I lose some more weight, but I'm already, like, feeling like at that store or whatever. So I tried it, and the the effect was pretty remarkable and pretty immediate. And within maybe about a week, I was feeling so much better.

I didn't gain a bunch of weight back in a week, but I had a lot more energy. My brain fog cleared. My inflammation markers dropped substantially actually into the normal range.

[00:11:06.700] - Dr. Gordon
In 1 week?

[00:11:08.260] - Nick Norwitz

In 1 week, including my calprotectin, which is a marker of inflammation in the stool. It dropped to its lowest level ever well into the normal range, coinciding with improvements in my physical function. 

[00:11:22.470] - Dr. Lemanne
Could you could you talk a little bit about--sorry to interrupt you, but I I really I think our our listeners wanna know, there are a lot of flavors of the ketogenic diet. Were you Yeah. Doing a carnivore diet? Were you doing a vegetarian keto diet? What what was the approach that you were taking at the very beginning?

And, we'll talk a little bit later, I hope, about how you might have adjusted that as time time went on.

[00:11:41.770] - Nick Norwitz
So I have toggled my ketogenic diet a lot over the past 5 years. It's been over 5 years now that I've been on it. But when I started it, I did, not what people see as the ketogenic diet on the Internet, but more Mediterranean esque keto. Like, I was eating lots of leafy greens, avocado, lots of fatty fish, not a lot of red meat. And when I did eat red meat, probably more on the leaner side.

I did eat some full fat dairy, but my primary fat sources were things like macadamia nuts and, extra virgin olive oil. I ate a lot of olive oil. And, that didn't clear all of my symptoms, but it really did make the worst of them go away. And the inflammatory bowel disease symptoms went away as in no more blood, no more profuse diarrhea. I can go out into the world.

I had energy again, anemia resolved, things like that. So it was really a remarkable step. I started with that because I saw it as kind of an intersection between what I felt at the time was healthy.

[00:12:42.770] - Nick Norwitz
I was still in the mindset that, you know, things like, you know, leafy greens, monounsaturated and polyunsaturated fats were much healthier than things like red meat and saturated fat. That's where I was at the time when I was first trying a ketogenic diet. So that's what my diet looked like.

[00:12:57.770] - Dr. Lemanne
Wow. Okay. Have you changed, your ideas? I mean, it is so do you now have a different idea about the healthfulness of leafy greens versus, saturated fat in in meats, dairy products, those kinds of things? Talk a little bit about that.

Tell us a little bit about the carnivore diet. Have you actually I know you've studied it. Have you tried it? Mhmm.

[00:13:17.230] - Nick Norwitz
I've tried a carnivore diet. I've done, like, full carnivore for up to 5 months. It does work well for GI issues. It's probably the best my my stomach's ever been. As I've delved into it, I've certainly become a lot more skeptical about the common knowledge around the healthfulness or lack thereof of things like saturated olive oil, fatty fish are super healthy for lots of reasons, but I definitely think that, you know, red meat, saturated fat have been unfairly vilified.

[00:13:56.080] - Nick Norwitz

So it can definitely be part of a healthy diet. I am not dogmatic about it as in if somebody can do a healthy plant based diet as well, and I don't think people need red meat. But I also don't think it's something that should be avoided for health purposes. Obviously, that's very contextual. You know?

Things vary based based on metabolic context. Also, if you're eating a low carbohydrate, high saturated fat diet versus, like, a high saturated fat, high carb diet, those are very different metabolic contexts. So it is context dependent. But I don't think these foods are inherently unhealthy. We can go down the rabbit hole on that quite a bit, but I think to come to that realization, it took a lot of a lot of digging into the sources of, you know, where this common knowledge comes from, delving into the data, and some of it's a lot more shaky than than 1 might believe.

When you start on your academic journey, when you're, like, you know, starting your PhD and you're you're getting into writing papers for the first time or first time seriously, you have this idea of the peer reviewed literature that it's like, you know, a meritocracy, a seal of approval, something that is, you know, reliable, you go down the rabbit hole a little bit or you just get some experience in the space. You realize that the peer review process is, you know, fallible. There's confirmation bias, and you get to see how narratives can be built, in this psyche of the biomedical community. So that's a whole another discussion.

[00:15:34.350] - Dr. Gordon
Do you have so, speaking as a farm advocate here, in your own world or in the people you coach, do you prefer grass fed meat and eggs and chicken?

[00:15:47.190] - Nick Norwitz
I try to get, like, you know, pasture raised chickens and, regeneratively regeneratively raised beef primarily for ethical and environmental purposes, to be perfectly honest. I'm not convinced that say, like, grain fed versus grass fed beef has a big health difference, But these are difficult topics because, I mean, when you're discussing things like red meat consumption, there are lots of conversations you can have around it with respect to, you know, climate change, with respect to animal welfare, and with respect to health. And those are distinct conversations. It's not like they line up perfectly in every dimension. So I'm definitely not someone who would say the whole world should eat a meat heavy diet.

I think that would actually be problematic, but for reasons that are not related to human health. Mhmm. So, you know, my area of expertise is human health and metabolism, not climate science. But I do also think to that to advance our understanding of the, you know, metabolic utility of some of these interventions, including a carnivore diet, which I think is fascinating. We do have to take a step back and acknowledge, look.

[00:16:57.360] - Nick Norwitz
This is a potentially very potent metabolic health intervention that requires further study. It may be really fantastic for some patients, does not mean every human should be carnivore or that carnivore diet is the optimal diet. I mean, as a weird analogy, you could, like, think about, yeah, anesthetics in a hospital. Like, they generate a lot of greenhouse gasses. Are we not gonna use them and just not use anesthesia during surgery?

Like, no. Of course, we are. We're gonna use them in a very targeted and thoughtful way. And I think the same can be true of, these, quote, extreme diets, like a carnivore diet. Like, there's biological plausibility there for how it could help with different conditions.

But in order to, you know, advance the research on it, we also have to be nondogmatic in the sense that just because it helps, you or someone you know that's a loved 1 or a patient with a particular metabolic condition doesn't mean it's the holy grail for human nutrition, the climate, yada yada yada. You don't have to discredit other issues in order to validate the metabolic success you have or the interest you have in this as a topic in metabolic health?

[00:18:02.230] - Dr. Gordon
Mhmm. Or the conflicting metabolic results. You know, I've I've used carnivore diet therapeutically mostly with people who have small intestinal bowel overgrowth. Now I've got somebody with colitis that I'm gonna suggest it to them too. And their primary problem in the SIBO situation was that they lost too much weight on the carnivore diet.

[00:18:20.770] - Nick Norwitz
Yeah. It's very effective for that. I mean, just to kinda break it down a little bit, the way it can be used in the ways it can work, say, for inflammatory bowel disease. You know, we have data showing that ketosis may be helpful, including things like an inverse association between ketone bodies and IBD activity in patients with IBD. And patients with IBD also have lower intestinal ketones.

Could talk more about intestinal ketones for other purposes.

[00:18:43.800] - Dr. Gordon
That was wonderful.

[00:18:44.610] - Nick Norwitz
Disease in a minute. Yeah. But so ketones might be helpful. But there's also data showing that fiber elimination can be helpful in inflammatory bowel disease.

[00:18:53.330] - Dr. Gordon
I'm sorry. That's going against the religion of gastroenterology incorporated.

[00:18:58.340] - Nick Norwitz
So so I mean, this is published in it was one of the cell press journals, I believe, where it's actually known for pediatric Crohn's disease that is treatment resistant. You give kids fiber free liquid diets, and it can put kids into remission 60 to 85 percent of the time. And it has to do with changes in the microbiome, in in particular, I think changes in, like, the intestinal geography of a mucosporillium pathobiome. So, like, you can get pretty specific. And to your point about, like, the dogma and the conventional knowledge, I understand.

I do understand the, the the reflexive reaction of, like, oh, this is a dangerous idea because it's gonna, you know, tell people that, like, fiber is bad for you. To be clear, I'm not saying that. What I'm saying is for this particular therapeutic use case, there is biological plausibility here related to things we already do clinically. This deserves further study. And, also, for those patients who are in a desperate place, this might be something worth trialing because it could help them when they need support.

[00:20:03.230] - Nick Norwitz
And that does not mean a carnivore eye is gonna extend longevity. It does not mean fiber is bad for you. It does not mean a carnivore diet is good for most people. It means this might help specific people. And that doesn't seem like an actual extreme stance, but the diet is overall seen as extreme just because those positions are conflated when they shouldn't be.

So when I talk about any of these things, I try to be really specific to be like, you know, what is the endpoint we are talking about here? Because I think that's how we actually like, people okay. If somebody's listening and they're a let's say they're in a carnival evangelist. I'm using that term very intentionally. I understand your enthusiasm.

Maybe you tried it and transform your life. And from a place of love and concern, you want that from other people. I understand that. But what you really want is for the world to accept this as something very powerful that can be used. And for in order for that to happen, we need people that are both closed minded to it to become open minded to it.

[00:21:09.830] - Nick Norwitz
The way we do that is be you know, speak with softer tone. It's like a you know, you attract more bees with honey than with vinegar kind of approach. Like, be very measured in the claims you make and the questions you ask, and then I actually think we can make progress. And I do think through that approach, you know, in in 10, 20 years, carnivore diets won't be seen as extreme at all. They'll be seen as targeted metabolic therapies for particular conditions, and hopefully, we we will have invested in more, you know, research to prove that's the case for x, y, and z conditions.

[00:21:44.540] - Dr. Lemanne
You know, you've talked, you said something a little bit, earlier that, the ulcerative colitis, going back to that, your experience with that, you you called it a metabolic disease. And when I was in medical school, it was called a rheumatologic disease and then later autoimmune. And I think, you know, what you're getting at is that underlying all of these, chronic conditions that we struggle with in our society so much, you know, neurodegenerative diseases, neoplastic disorders, you know, frankly, metabolic things that are recognized, like diabetes and high blood pressure, but heart disease. You've been trying to get us to think, us being the older medical establishment, about the underlying commonalities of these conditions. Could you talk a little bit more about how you came to that and what you hope will happen in the next few years, in that realm and the and the way that we think about these things?

[00:22:40.600] - Nick Norwitz
Sure. I guess the the first thing I should try to do is define, like, what is metabolic health and what is metabolic disease? Because it is a broad term that is not well defined and intentionally so. Because I think, you know, when you talk about something like ulcerative colitis, we don't have a clear linear picture of the ideology, the pathogenesis of this disease. And, yes, there are probably autoimmune contributions, rheumatological contributions, like a lot of contributions.

I think they can all be swept under the umbrella, be it cardiovascular disease, diabetes, obesity, of human metabolism. How our bodies, like, software runs, how our bodies handle energy. It's really a Venn diagram of sorts, the way I think about it. Like, all these terms we use, and they're all interrelated to how our bodies use and process energy and nutrients. So metabolism, which overlaps with endocrinology and hormones.

[00:23:44.530] - Nick Norwitz
It is not that well defined because it's difficult to operationalize, and you do that with outcome variables that are specific to, say, the disease condition that is of greatest interest. But from, like, a a well, to use an analogy, the way I think about it is we have all these diseases we're we're we're seeing now. Inflammatory bowel disease or an autoimmune inflammatory conditions, neurological conditions, diabetes, cardiovascular disease, obesity. And we can see them as unique conditions, or we can see them as manifestations of dysfunctional metabolism akin to if you have a tree, and you can imagine, like, all the leaves or all the branches are these different diseases or perceived to be different diseases, obesity, you know, diabetes, inflammatory bowel disease. What they all share is, you know, underlying common dysfunctional roots in soil.

 But the roots are things like inflammation, oxidative stress, mitochondrial dysfunction. And in order to make the overall tree healthier and cure what ails us, the metabolic diseases, at a very high level, we want metabolic therapy, by which I mean, like, lifestyle nutritional interventions to treat these metabolic diseases. It is as much as I love breaking down the mechanisms, and if you guys have been following me for a while, you know I do. Like, I love, like, new cell science in nature paper on, like, particular mechanisms that we can follow linearly. The fact of the matter is, you know, in real life, in real clinical medicine, it's never that clear.

We have the clinical trials. So I can do, you know, a clinical trial and say, look, he neurogenic diet helps in, multiple sclerosis. Then we have the mechanistic studies where I'm like, now I can take, you know, a mouse model and do fecal transplants and gene knockout and find, like, a linear pathway. But the reality of the clinical response is that it's a complex meshwork of all the mechanisms. And we don't need to fully understand what that, you know, that cloud, that meshwork looks like.

[00:25:49.450] - Nick Norwitz
We don't need to have the full resolution before we start implementing these things clinically. And, again, at a high level, the underlying metabolic dysfunction is what's contributing to all these chronic metabolic diseases. And it's important, I think, to take that approach. Because in doing so, you want to target, you know, the the roots in the soil of the tree of metabolic disease rather than kind of just taking shears and going at the the branches, which we do now with pills and procedures that are based on randomized controlled trials where you're looking at monotherapy, or generally monotherapy for these particular diseases. So it, you know, it is a a a shift in mindset, and it will be a large scale if we do make that shift societal experiment.

But it's one we need because the conventional approach simply isn't working.

[00:26:45.290] - Dr. Lemanne
Well, you talk a lot about n of 1. As you know, large societal shifts. But you talk a lot about n of 1, which really fascinates me. I was at a oncology conference about 5 years ago, and 1 of the funders from the FDA, stood up and said, hey. You oncologists have been studying cancer with large, randomized, controlled trials for decades, and these trials cost, tens of 1,000,000,000 of dollars, and you've gotten no cures, none, over these decades 

[00:27:13.040] - Dr. Lemanne
We want you know, we suggest that, you start thinking about, having each cancer patient be an n of 1. And this was at this meeting 5 years ago, and I remember, you know, kind of everybody, you know, sat back and and took this in. And, you're implementing that in a in very nice ways. I've I've read some of your n of 1 trials, the 1 with eggs and the Oreo cookies and--

[00:27:38.000] - Dr. Gordon
And we're gonna have to link to those just in case 

[00:27:40.080] - Dr. Lemanne
Tell us a little bit more about how you think, about n of 1 trials, and, how we, doctors and our patients, might start implementing those in our in our clinical lives here.

[00:27:51.100] - Nick Norwitz
Right. Well, I think oncology is a great space to kind of examine this because, you know, we know that humans are very heterogeneous and different diseases have different pathophysiologies in different people. I can't think of anywhere where that's more true than cancers. Cancers are defined by being complex and heterogeneous. So you would know the statistics better than me, but, like, if you do a randomized control trial for a new drug for a particular cancer, what proportion of people does it actually help?and to what degree?

[00:28:21.820] - Dr. Lemanne
I can tell you that. Yes. Yeah. And, we love it when, our for instance, in breast cancer, when we get a 2 to 3% improvement in overall survival in 5, 10, 15 years, that's a success. And we use that drug on all 100 patients in for to help 2 or 3 of them.

[00:28:39.250] - Nick Norwitz
So yeah. So so when the randomized control trial comes out, you have a quote statistically significant effect. And, you know, 1 way you could think about it is, yeah, there are some people that really get helped, but actually the majority might not be helped.

[00:28:52.990] - Dr. Lemanne
Right.

[00:28:53.230] - Nick Norwitz
And the drug is still quote effective on a population scale. But if you're helping, let's say, helping 3% of people, I know that's not exactly what you said, but that's just for for argument's sake. What about the other 97% that it didn't help? Like, it doesn't matter what the randomized control trial said with respect to statistical significance, the majority did not get helped.

[00:29:12.010] - Dr. Lemanne
Mm-hmm...

[00:29:12.890] - Nick Norwitz
And another way to think about this is rather than running large trials on heterogeneous masses, because the populations we're studying are always heterogeneous, we could instead look at what is the underlying, you know, metabolic and biological dysfunction in this individual person. And we're gaining more and more technology where we can look at that. It's called, like, multiomics or longitudinal multiomics, where you look at an individual's, you know, metabolome, genome, proteome, microbiome, and you use machine learning and AI to create this picture, or if you do it over time, this high resolution video of who that individual is, you know, has a metabolic organism. And, you know, if you have enough of those data, then you can start to identify the nodes of dysfunction that are specific to each individual, and then target those nodes in order to restore normal biological function and hopefully treat chronic metabolic disease. I mean, that's n equals 1 medicine in its most evolved form, or at least what I think is coming down the pipe.

We're not there yet per se, but I just want people to pause and think about how powerful that can be, but also how it's not conducive to the kind of trials we do now. The incentive structure of medicine and biomedical research right now, like the business structure. This doesn't say say anything per se negative about, like, procedures and pills, but there's a very clear business structure. You develop a drug, you put it in a randomized controlled trial, it helps a proportion of patients, then you sell it to the masses, and then the company makes money. The business structure for doing these kind of metabolic health interventions isn't as clear.

[00:30:59.450] - Nick Norwitz
You might help a lot more people. How do you make money off of it? And, you know, also in making it so, like, the n equals 1 approach is a lot more specific and more powerful, I think, but it does require more innovation and thought and less algorithmic thinking. So how we're gonna shift, you know, how how we're gonna shift the incentive structures even to make this plausible is something that's a little bit beyond me. We can talk about that a bit more, but I do think in order to have, you know, high efficacy and effectiveness for product metabolic diseases, we are gonna have to make the shift to asking in each individual case, what's going on here, and what are the nodes and metabolism that we can target, and how do we target that?

All that said, you don't need complex microbiome and genome analyzes as an individual to engage in an n equals 1 health journey. All that is to me is engaging in the scientific method as applies to your own life. And the scientific method isn't that complicated. You identify an outcome measure you care about. You hypothesize what might change that outcome measure.

[00:32:18.500] - Nick Norwitz
You implement an intervention in line with that hypothesis, and then you assess the data with curiosity, and then you iterate. So you can do this as an individual very simply, and your data can be things like, you know, body composition, could be hormones. It could just be your subjective feeling. It could be kind of anything. But the power of n equals 1, I think, is twofold.

[00:32:42.790] - Nick Norwitz
1, that kind of application I just talked about using, you know, new technology that's arising, and 2, to empower every individual now to be at the helm of their own, you know, health journey, their own metabolic health ship, if you were. And and what I've seen through my far more limited clinical experience than either of you 2, but that when you empower people with that perspective, even if they don't have a scientific or medical background, when they engage in that approach, hopefully, with the support of a supportive clinician, they can make unbelievable progress and transform their lives in ways they could never have imagined. So I think it's powerful right now and today. Mhmm.

[00:33:25.250] - Dr. Gordon
It's a nice blend of your science orientation, which, you know, half of the things you write, half of the articles above my head. But when we're talking you're talking about the clinical work or particularly some of the patients you've coached. Like, I've I met Dave Dana on Twitter. I saw his he had a hero's journey, and you accompanied him. And, clearly, you weren't sharing statistical tables and microbiome, you know, insights of the mass scientific community with him, but you got him somehow interested in approaching his health challenge in an optimistic way.

[00:34:03.150] - Dr. Gordon
In some I'm not sure how  you get both of these to p'ay well, one--the first one, the Parkinson's patient that you talked about asked you Mhmm. How did you encounter your patient that is you know, you're talking about him openly, so I assume we can talk about him here too by name. Yeah. How did, how did you start with him, and how did you, learn how did you learn to be a health coach when you're an MD, at PhD, like, busy on the left side of your brain?

[00:34:30.780] - Nick Norwitz
Yeah. I mean, it it it's not too complicated. I think basic emotional intelligence to see when someone's hurting, in need of help, and also when they have that fire in their belly and that they're gonna be receptive to the help. Mhmm. A clinician mentor of mine once said, very wisely, you can't want it more than the patient

[00:34:52.640] - Nick Norwitz
Mhmm. So there's some people that you can just like they're not ready to change. You know, when they're ready, you'll be there for them. But there are those other people that come to you, and they're like, look. I really wanna change.

[00:35:02.670] - Nick Norwitz

I just don't know how to make the first steps. And I don't even remember exactly how I got in contact with Dave. I don't remember if I reached out to him or if you reached out to me. But it was just someone where, like, you know, I could see person to person, like, this person's motivated. He just needs a nudge in the right direction.

And I also had a lot of empathy because I know what it's like to, you know, be confused and frustrated about, you know, conventional knowledge and not sure where to start and just needing a little bit of support. And so that's where we started. And then you're just meeting an individual where they are with respect to their knowledge base and feeding them what you think they're gonna be receptive towards with respect to information. I think even if someone doesn't have you know, can't understand all the nuances of the science, you can always still boil down like, look. This new paper came out in a top journal, and here are the takeaway points.

Like today, I posted a video on ketogenic fat from multiple sclerosis, and I can make it very simple for you or for a person. It's like these new data, kind of build upon existing literature that this low carb diet can help even in human clinical trials with this neurological disease. And this really cool mechanistic paper is showing how it works. Basically, the diet actually changes the composition of the metabolism of gut bacteria to make them make another compound that shuts down inflammation in the body. And this might help, you know, treat neurological disorder

[00:36:27.680] - Nick Norwitz
Like, there's not a ton of jargon there. I think most people can understand that. And if you wanna go down the rabbit hole, it's like a Russian Russian nesting approach. Right?

[00:36:34.080] - Dr. Lemanne
Right.

[00:36:34.400] - Nick Norwitz
You can start with the tweet and the Instagram reel, then you can go to the longer form YouTube video. You wanna go to the newsletter, you wanna go into the papers, like, you can always do that, and you meet people where they are. And the funny thing about health coaching to make it another, like, you know, n equals 1 in scientific process is like, I don't need to tell you, but you meet someone, you hypothesize what they might be receptive to, and then you try it. And then you see how they do. If they're really receptive to something and, like, this motivated them, then you give them more of that.

[00:37:03.040] - Nick Norwitz
If it didn't work, then try something else. So, you know, acting as a physician or a health care provider in it in and of itself is a kind of, you know, a scientific process. The question then is how you scale it, you know, via social media, and then and then that's just providing different forms of content and different breakdowns. So, yeah, it's been a lot of fun. But but Dave is somebody who I'm I'm particularly proud of, his transformation.

[00:37:30.270] - Dr. Gordon
He's great. You have amazing video skills. Do you really do your own YouTube videos, animation, and everything?

[00:37:38.190] - Nick Norwitz

Oh, no. Like, I learned to do that. So, like, it's 1 of those things where, like, you wanna learn the skills along the way. So, like, I've learned to do some video editing, but, like, to do a video editing, like, some of my my more recent videos would to do, like, a worse version of that probably would take me 12, 16 hours. Now I outsource it.

So, basically, my process is I'll read a paper. You know? I'll, write down notes for it, write a quick script, and then record it. And then, I have a a a thumbnail, friend. His name's Andrew.

He approached me on LinkedIn, and he's brilliant. It's like the DaVinci of thumbnails. I think he's so great. And so he'll do thumbnails for me, and then I, outsourced it to just some editors. 1 I found on Fiverr.

[00:38:21.320] - Nick Norwitz
Again, somebody else who approached me on LinkedIn. So it's it's a distributed effort. But, no, I I would put 1 video out per month if I were doing my own editing. Yeah. So, you know, I--

[00:38:32.830] - Dr. Gordon
Kind of the pace of our kind of the pace of our podcast. You know? We might record them weekly, but then we don't release them for a month or so because we, well, Tom does it with us. But, you know, we do some of the editing. But, you know, I think, your work in your social media presence, I don't know any, Doctor Bredesen I think he has agents that work for him that post some things on social media.

But your highly engaging social media is an n of 1, approach to kind of how might we change the world.

[00:39:05.800] - Nick Norwitz
It's interesting. I mean, I'm so early in this process. People that are bigger than me have, like, whole teams to manage all the it's a lot. Managing, like, Twitter and YouTube and Instagram and everything.

[00:39:17.660] - Dr. Lemanne
As well as medical school.

[00:39:18.860] - Nick Norwitz

Have people who can, like, do that. But, like, you know, it starts off it starts off like anything. Like, I have my phone that I would record on, and then I go to, like, Imovie and, like, drop some things, and I toss it on YouTube with a thumbnail made on PowerPoint. And, like, that's where it starts. And then you build a little bit momentum, and you can start, like, delegating some things, like editing and thumbnail creation, and you just get more and more efficient.

And like in medicine, you wanna operate at the top of your license and not do every single job, and you learn to delegate and build teams, and exert leadership. I'm still very early on being, you know, let's say, quote an intentional influencer. So in, yeah, in 3 to 5 years, I'd like to have someone that's doing a little bit more of the social media management. But right now, it's me on the back end of everything. So if I put out a tweet or an Instagram post, it's me for now.

 Again, like, chopping all these things up, turning a video into a real and capture like, they're not the things I wanna be doing with my time. But for now, I think it's it's useful to learn the skills before then later down the line when you delegate. And right now, I don't have the the budget to hire a team. So we'll see how things develop. The nice thing about being me is I kinda got a time edge on a lot of people in the space, by which I mean, like, they're the human beings and the Peter Attias who have grown quite a bit.

[00:40:33.570] - Nick Norwitz
I got 20 years plus before I'm at their stage, so we'll see how things develop. It's really exciting to be entering the world as a scientist, and young doctor at this point in time because these prior generations did not have access to the tools and opportunities I had. So there isn't really someone to model my career path on, which makes it kinda fun and exhilarating, but I'm still very much very much learning this. I spent the last decade plus learning cell biology, biochemistry, learning to do clinical trials, and wet lab work. So, like, transitioning to be like, let's learn media and marketing and business is a whole different skill set.

[00:41:14.600] - Nick Norwitz
But one I'm gonna try to develop quickly. It's only been, like, honestly, like, less than a year of of doing this intentionally. So..

[00:41:24.180] - Dr. Lemanne
When do you graduate from medical school? Yeah. I think that's, you know, Monday. Okay. Soon.

[00:41:28.260] - Dr. Lemanne
And what are you gonna do after that? There's no specialty of metabolism at the moment. So what's what's next for you in terms of formal education and and career path in that regard? What will you be calling yourself?

[00:41:39.840] - Nick Norwitz
I don't know if I've said this officially on a podcast, but, I'm not applying to residency. This is a new decision that I made back in June after a lot of thought talking to a lot of people. I initially wanted to do maybe pediatrics into pediatric endo or internal medicine. And I I would see the value to some extent of doing a, you know, an an internship and a residency, but some opportunities just presented themselves that were a little bit too enticing at this point in time 

[00:42:10.090] - Dr. Lemanne

[00:42:10.890] - Nick Norwitz
And, you know, like anything I or anyone, I got to that point in my life where you really start to have to choose about, like, what you want to do. Do I care more about the science and advocacy and public education, you know, running trials, the clinical medicine? What can I do in the clinical space, you know, without a residency? And at this point in time, I decided the best path for me was to to jump off the deep end a little bit and try something alternative. A lot of thought went into it.

After I graduate, I'll probably give a bit more of of more of my backstory and the rationale behind that decision. But, no, I'm gonna I'm gonna try something different. Let's just put it like that. So it will include a lot more of public Nick and, more research. But I actually think this is the way that I'm gonna have the biggest impact rather than going via the, conventional route, which I had at the forefront of my mind for the last 2 decades.

[00:43:13.480] - Nick Norwitz
So this is it was a big shift in my world, but I'm confident it was the right decision for me.

 [00:43:19.090] - Dr. Lemanne
Wow. Well, we're honored that you've, we've been the first ones that you've shared that with, and, I'm sure it'll be a a great adventure and a a boon for the rest of us to see, you know, how you can help us navigate the future of of medicine, which really needs some some big sea changes. So we're we're looking forward to seeing what you're you're going to do. I I have to go.

[00:43:45.390] - Dr. Gordon
We're bumping up against clocks at both ends here. Yeah. Yeah.

[00:43:48.670] - Dr. Gordon
Nick, thank you so much. And, I have about 27 more questions to ask you, but I'll limit myself to just a couple now that I have your email. I'll ask you and share them that way.

[00:43:59.760] - Nick Norwitz
Okay.

[00:44:00.400] - Dr. Lemanne
This has been amazing. Thank you so much. Our audience will be just thrilled to hear from you and to to learn all of these new things that you're doing and, how they can get involved too, and we'll discuss that with them. So thank you

[00:44:13.940] - Nick Norwitz
Thank you so much. Can I plug one thing actually quickly before we we jump off? Absolutely. So, it's really nice for me to be here with you guys, senior clinicians who are also excited about metabolic health.

[00:44:25.310] - Nick Norwitz
I think, you know, at the different, you know, generations of health care, we need this. And, 1 thing, you know, I I think is important to do, and I I'm gonna guess you're in agreement, is capturing people early on in their medical process. So, I'm actually working with there are a few, medical school prep like, MCAT prep companies. So it's like Princeton Review, Kaplan. One's Exam Crackers.

[00:44:50.770] - Nick Norwitz
They've just invested a lot into a new platform, a Metabolic Map, and I've been talking with the CEO. And 1 thing we have going is a putting Metabolic Health back in, medicine or putting Metabolic Health in Medicine. I don't know if it was ever there. Initiative. So, some things we're doing, for example, is, you know, normally, MCAT, you know, prep materials cost 100 of dollars.

[00:45:11.430] - Nick Norwitz
We're providing free, MCAT style prep questions written by writers who scored a 100th percentile on their MCAT, but they're based on papers that I cover in my videos. So that's a new science paper on, sugar exposure, in utero or the new 1 on hidden ketones out in cell reports or lysophosphatidylcholine in Alzheimer's disease, the microbiome. We're breaking down 2024 in, like, recent cell science nature papers, putting them as MCAT prep materials, and providing them free in conjunction with video breakdowns I do for students who want to study for the MCAT while also, learning about metabolism, getting excited about metabolism even before they start med school. So, people can check out Exam Crackers, Nick Norwitz. Just Google that. 

[00:45:59.700] - Nick Norwitz
You'll probably find it for some free passages. See if it interests you. We're also gonna try to turn these into CME accredited materials so that current and future doctors can learn together about metabolic health. So I'm excited about that. It's a new initiative that we we we're just launching.

[00:46:16.250] - Dr. Lemanne
we're happy to support and plug that. And if and we will put, the information in our show notes. If there are any links that you'd like to have in I'll provide those. The show notes. Please send them to us, and we will get them in there.

[00:46:28.570] - Nick Norwitz
Fantastic. Yeah. Well, thank you so much for your time

[00:46:31.780] - Dr. Gordon
Thank you. Likewise. I look forward to the next conversation.

[00:46:34.020] - Dr. Lemanne
Alright. Beautiful. All the best to you.

[00:46:36.020] - Dr. Gordon
Great talking to you.

[00:46:36.890] - Dr. Lemanne
Bye bye. Bye bye.

[00:46:39.860] - Dr. Gordon
You have been listening to the Lamon Gordon podcast where docs talk

[00:46:44.930] - Dr. Lemanne
shop. For podcast transcripts, episode notes, and links, and more, please visit the podcast website at docstalkshop.com. Happy eavesdropping. Everything presented in this podcast is for educational and informational purposes only and should not be construed as medical advice. No doctor patient relationship is established or implied.

[00:47:16.830] - Dr. Lemanne
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[00:47:21.870] - Dr. Gordon'
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[00:47:33.950] - Dr. Lemanne
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[00:47:48.540] - Dr. Gordon

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[00:47:55.180] - Dr. Lemanne
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[00:48:12.960] - Dr. Gordon
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