Understanding The Lean Mass Hyper Responder w/ Dr. Nick Norwitz & Dave Feldman | The Metabolic Link

We’ve just launched an extra and exciting episode of The Metabolic Link podcast! It features an eye-opening conversation between our host Dominic D’Agostino PhD, and guests Dave Feldman and Dr. Nick Norwitz, two researchers and MHS 2024 speakers spearheading investigations into the lean mass hyperresponder (LMHR) phenotype.
Dave Feldman is a software engineer who became deeply interested in lipidology after seeing his cholesterol spike on a low-carb, high-fat diet. He has since performed self-experiments and published several papers on the possible mechanisms behind LMHR. He is currently conducting a clinical study out of UCLA through his newly formed public charity, the Citizen Science Foundation.
Nicholas Norwitz completed his PhD at the University of Oxford and his thesis focused on ketone metabolism and neurodegenerative diseases. He is currently a medical student at Harvard Medical School.
In this episode Dave, Dr. Norwitz, and Dr. D'Agostino dive into…
-The debate around whether saturated fat drives increased LDL levels, especially in the LMHR phenotype.
-The "Lipid Energy Model" hypothesizing a metabolic/physiological process underlying LMHR phenotype.
-Concerns about erroneously grouping lean mass hyperresponders with familial hypercholesterolemia patients.
-The importance of separating discussions of underlying mechanism from clinical recommendations.
-Their vision for the future direction of LMHR research and public education on this topic.
Be sure to secure your spot at MHS 2024 in Clearwater Beach, Florida, where Dave and Nick will be presenting their latest research! Both virtual and in-person seats are still available at metabolichealthsummit.com.
In every episode of The Metabolic Link, we’ll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!
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*Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

[@eugeniebreida1583]

So appreciative that students/Phd’s like Dr. Norwitz have/are suffering some ‘popular/modern’ diseases, such that they are directled directly interested in issues that so many of us have. (Autoimmune here, very lean, and wanting to eat carnivore to keep inflammation lowest possible)

[@ylcalif3681]

Quite a few people in the comments are asking why most people seek out a low carb lifestyle. I went low carb after barely bumping into pre-diabetes. Then cholesterol increased and Dr. was pushing me to take statins. My HDL was 98 with Trigs low at 56 so I knew my HDL/Trig ratio indicated low risk of CVD and I refused the Statin. These LMHR videos (and a low calcium score) gave me the confidence to refuse statins. THANK YOU FOR YOUR WORK!! PS: Glucose is now normal because of the low-carb diet.

[@gregmaurer1]

So exciting - what a contribution - bravo! Do not let the established scientific community get you down - every major move forward comes from people who are not overly stuck within an existing scientific community because there is a strong tendency to be so indoctrinated in the current popular paradigm. Keep doing what you do - it is so important!

[@scoobydadog246]

It is, although I wish they weren't so focused on the cholesterol lowering drugs. I think looking at the thyroid, the T3 issue would be a good idea Not sure how much they've delved into it, but sounds like they are assuming a 'normal' TSH means someone isn't hypothyroid and that is not true. High LDL (really high) has always been associated with hypothyroid. If t3 is low.. perhaps T3 supplementation would be an easy intervention to try with less nasty side effects than statins and that drug that begins with Z :)

[@LakeOuachita]

Dave and Dr. Nick are my new heroes! My goal for 2024 to become a LMHR! "Stay curious!"

[@JesseStarks]

Seriously. Great stuff.

[@cheribowling4555]

I’m 68 diagnosed with FH 5 years ago, put on statins. Have CAC score of 1200! Am athletic, swimmer now, vet active 112 lbs. Not sure if I’m a hyper responder or have FH but was put on Zetia with statin and lost 10 pounds, about a lb a week until the gut issues were unbearable. Constipation was impossible to manage. But it did work! LDL dropped to normal levels!

[@moaink99]

Such exciting and inspiring work!

[@RobertWinter2]

Great discussion. I hope you get your giant lab Dave and Nick.

[@craftycalley]

Really enjoyed this video. I sat here making notes. I just wish the worldwide numbering about levels of cholesterol were the same as here in the UK I’m considered normal at 4.8. Your numbering system is a whole different language! I suspect I’m a LMHR as it went way up when I did keto the first time and the way I got it back down was to eat more carbs…..irritatingly! I’m having a blood test in March and am back to low level carbs on a ketovore diet as that’s what I think will be my way forward.

[@brucemckay6615]

Measurement systems… American’s… what can u do??

[@carmenross1077]

Yup I went low carb and I’m Lmhr my doctors are freaking out pushing a statin injection and po statins,in which I develop all sorts of allergy. I guest safer to go low carb as much as possible

[@michalsobczak3535]

Such a refreshing conversation especially in comparison to the dreadful exchange between Dave and Ethan Weiss. The difference is that Dom understands that the boys are on something big vs Ethan who describes their work as crappy.

[@HEARTANDSOULOFMINE]

Who is Ethan Weiss?

[@christinekinn6178]

There was mention of a limited concern with identifying genotypes. Is there anyone who is looking at comparing broad spectrum genetic variances in populations that present with common metabolic traits? Do the studies you mentioned include genetic profiles of the participants so that you or other researchers can delve into that?

[@robyn3349]

Thank you! I am most interested in knowing the risks of LMHR as I had very negative side effects from the meds prescribed to me for elevated cholesterol. I will never take a statin or zetia again.

[@HEARTANDSOULOFMINE]

What were your side effects? My APOB is sky high and both meds have been recommended to lower it.

[@barbarafairbanks4578]

​@HEARTANDSOULOFMINE I wouldn't even go there, i.e.- you really don't want to know - going into this space. ( e.g., placebo effect - which is a very real phenomenon. Also, if I have my facts straight - I believe the stats for population side-effects for statins is something like 2% (I believe this is from Dr. Peter Attia.) Dr. Attia has said that there are various statins to try, if his pt. Is experiencing side effects on one - switch to another and many times the alternate will not create side effects. Also, aside from statins there are PCSK9 inhibitors to reduce LDL with generally no side effects. (c/b pricey, though, if your insurance provider nixes it as an alternate).

[@scoobydadog246]

@@barbarafairbanks4578 Placebo effect my 'arse. (I am jesting, not being mean, but they are real and common! Please look up how statins work, and all the pathways they block! There is physiology behind the side effects! Attia is a "TY doc" - i.e anyone that big time on YT (which is basically mainstream medicaine now) is pushing the mainstream agenda. - Statins. Even on the toob there is a lot of information about the negative effects , etc. I wouldn't trust Attia or anyone like him who is making a LOT of $$ in his role no doubt funded by the pharma companies. Way before all the fancy (and profitable drugs) LDL was treated with thyroid hormone.. b/c very high LDL was associated with that. Even these guys need to dive into Thyroid - i don''t think they have - especially if ppl are symtomatic. TSH is not a reliable indicator of thyroid function, and that is all that is normally looked at. A lot of these people have low t3. I beleive the low carb community likes to say that is okay, but i don't think it is. Why not just supplement thyroid, and see what happens? No negative side effects. Of course it is cheap and drug companies don't profit from.

[@ylcalif3681]

Find out what your Calcium score is . . . if you don't have plaque buildup, why worry about LDL?

[@barbarafairbanks4578]

@ylcalif3681 no, I think this is not good advice - per Dr. Peter Attia (IIRC) And, you know I don't recall the reasoning behind it. But a low or 0 Calc score (though better than a high score) - still does not negate a sky-high LDL marker. Pretty sure it was Attia who said this in one of his podcasts on the subject.

[@thefisherking78]

Thrse guys are heroes to me, and I'm not even an LMHR

[@jenniferhultberg237]

Got my lipids panel back last week. Cholesterol total 515, HDL 79, triglycerides 135. I think that’s makes my LDL 421 if my calculations are correct. Doctor just ran blood work a 2nd time she thought it was an error, I don’t think so. I’m low carb for a long time, I’m menopausal, on HRT, I exercise to an extreme, do intermittent fasting, eat saturated fats and my BMI last checked was 23 but I lost weight since then. I’m not LMHR due to my triglycerides. I will get my plaque checked at some point but wondered about anyone’s thoughts here. Oh Both parents were on statins but who knows if that was necessary. Loved this interview, thank you for doing these studies, so grateful. Thanks in advance everyone for your opinions.

[@speedyswede5585]

Does "exercise to an extreme" include serious resistance work (or lifting weights) appx 3x a week? Are you down to the keto level of low carb? Wish I could think of some more ideas; good luck.

[@scoobydadog246]

Hi - I am also a post menopausal woman, so interested in your experience. FYI, there is also 'non HDL or LDL ' cholesterol, so the subtracting the HDL from total won't give the exact LDL number, although it would still be high no doubt (and probabably not too far off). You are close to LMHR, though :) How long have you been doing keto/carnivore? If not too long, maybe your TG will continue to go down? Mine were low to start with, and stayed exactly the same. I'm also interested in your HRT experience. How is your thyroid? I'm 63, BMI 17, LDL 311, HDL 118, TG 53 A1C 5.4 I'm sure I'm hypothyroid but fool doc i'm working with now wouldn't do labs. I have all the symptoms, I did before, and now worse; Hypo T is associated with high LDL. How are you feeling? At least for me, I think the thyroid is a big issue. TSH is not always a reliable marker, not sure if these guys have delved much into the thyroid world, i hope they do. In my 4 months on carnivore - I feel worse - less energy, gaining weight -not good weight, fat around my abdomen, so my bmi is probably a bit higher now, but still considered low, and I am so cold. So, in my case, I think I need some T3, but I also wonder about the other hormones. I honestly don't care about the cholesterol, but my doc will have a heart attack!!! I just want to feel good. And yes, everyone is put on statins after a certain age, or if cholesterol is high. I don't think they are ever a good idea, but that is my personal opinion. In fact, ppl with higher cholesterol live longer and have less disease - however I'm not sure about these 'super high" LDLs. I just got these labs, and am trying to figure it out. People don't talk much here on YT, I'm on twitta/x with this same name, there is some discussion there, and you can also DM me if you want to talk and compare notes!

[@ylcalif3681]

Your triglycerides at 135 is way too high to fit into the LMHR phenotype..

[@jenniferhultberg237]

@@ylcalif3681 ummm yes I said that in my post.

[@johnrecker]

Hi - if this helps. I am 28, BMI 22@171cm height. I exercise every day, move most of the day, and do carnivore diet for more than 2 years now, and a year of keto before that. My last blood work was HDL 86, LDL 410 and TG 116. CAC 0. I don't think just because my TG are slightly higher than what LMHR suggests I do not qualify as one, I think more data is needed from more people, which could raise the TG bar a bit..

[@scoobydadog246]

So glad to find this dicussion! I see the presenters aren't reading comments, so I guess I'm wasting time -but just in case :) Sometimes other readers have answers! I wish there was contact into for Nick, Dave, and Dominic; because I'd like to contact them for more info or to offer to be involved in any future study. Just got lipids after only 4 months on keto/carnivore: LDL jumped from 139 to 311. HDL 118, TG 53, total 432. A1C 5.4 F, 63 y/0 BMI 17.

[@connietrumpf2037]

Awesome HDL, TG and A1C.

[@scoobydadog246]

@@connietrumpf2037 Well, TY Connie... I didn't think anyone would notice :) Very kind of you to say. ;)

[@jesseherbert2585]

Also, isn't there an ongoing study right now of folks on ketogenic diets that is seeing low atherosclerotic plaque, even at very high LDL levels, for folks with non-high BMIs? If correct, perhaps high LDL is not even an issue...

[@GameofTrees]

Regarding Testosterone, mine has risen from the 300’s into the 900’s as I approach a year on Keto. Most recently LMHR either LDL 388 HDL 128 TV 68

[@dwytehexican9634]

Liked and subscribed

[@pauljohnmark]

Nick, Would you consider another arm to your Oreo statin trial? Assuming your fT3 is on the low end of normal, taking liothyronine 5-10mcg/d to increase your LDL receptor expression.

[@Bobbi-upnorth]

This is an incredible body of work and I look forward to more exciting info to come. Nobody is interested in funding this work because they can't make a pill to solve it.

[@TheAnimalBasedCure]

How much time does this transition to LMHR usually take? Ive been keto for little over a year now. Before keto my ldl was 137, 4 months in it was 140, 10 months in it was 168 and now 14 months in it is 193. Should i expect it to keep rising? Also my hdl went from 49 to 70 and my Triglycerides went from 87 to 57.

[@jennyyang2640]

I don’t eat a low carb diet but I do try to lower my carb intake. My triglyceride is 60, HDL of 72 and LDL of 120. I wonder if I go on a true low carb diet my LDL will go above 200.

[@altosack]

Are you lean? On a diet of ~80-100g carbs (almost all a _lot_ of greens, no grains), HDL = 78, TRG = 45, and a BMI of 22.5, my LDL was already ~200. Now, with ~50g carbs and a BMI of 22, LDL=275.

[@kenadams5504]

As an lmhr, my six- pack caused my hyper-cholesterolemia and cookies are the cure for my hyper-cholesterolemia (in quotes).

[@lisawanderess]

I fit the criteria for being a LMHR have been carnivore for almost a year which totally reversed autoimmune Rheumatoid Arthritis and Interstitial Cystitis and was able to get off biologic meds and feel awesome! A doctor I saw freaked out with that top cholesterol number (409) and wanted to put me on statins but I pointed out my perfect glucose levels, the CAC heart score of zero and triglycerides of 53 and the fact that I walk an hour a day and have no more inflammation markers in my blood and figured I was doing pretty well. He said "Nobody walks around with a cholesterol level of 10.6!!" (I'm in Australia, so we measure it differently, but it coverts to 409) My reply? "But here we are!" 😂

[@erinkieley7747]

How do be a part of the study? I started Keto/carnivore in August and my HDL has increased, LDL increased and Triglycerides have stayed the same (triglycerides increased at the last draw but I was not fasting. It was drawn at 4 pm I'm 52 yr old, 5 ft and 105 lbs, and have a lot of muscle

[@scoobydadog246]

I don't think the thyroid issue should be downplayed! Back before statins, high LDL was considered a sign of hypothyroidism, and was treated with thyroid supplementation! Now Drs. only rely on numbers, and don't look at clinical symptoms, including body temp measurements. TSH is NOT always a good indictor, b/c it can be normal with low T3, the active hormone. I know I am an N of 1 but I had low t3 with normal TSH before carnivore ;with symptoms. 4 months in, my hypo symptoms are much worse, and I am steadily gaining (unwanted weight). I am LMHR - LDL jumped from 139 to 311, HDL 118, TG 53, A1C 5.4 BMI 16.8 when started but hight now b/c I've gained about 10 lbs (not muscle). I would like to try T3 supplementation - I would feel better and potentially bring down LDL. Worth a try. Looking for a doc to work with me.

[@MountBlueice]

I am intrigued by the study. My guess is LMHR were healthy people to begin with. So such a low level of TG, LDL of 123 means they were insulin sensitive, no diabetics I presume. Similarly because of low to zero calcification I assume they were non-smokers as well and chances of not having hypertension. I know these are not mutually exclusive but it seems that was a group without metabolic disease and fairly healthy. What motivated them to follow Keto diet for 4+years which is very extreme diet and hard to follow?

[@scoobydadog246]

Hi! this is a great question! I'm just one, and I can answer for me! I was quite metabolically healthy prior to carnivore (4 months in).. LDL 139, HDL 136, TG 53, BMI 17. I didn't have fasting insulin testing, but based on everything and thriving on high carb diet, I think I was insulin sensitive. no issues with blood sugar. No smoker, BP normal, etc. I had horrible GI issues,/pain after a gall bladder surgery 10 years ago, and exreme fatigue, secondary to that. I did suspect hypo thyroid & did a lot of research, but doc not open minded. tried keto/carnivore after hearing so many stories of people healing from things like that. My issues were disabling (won't go into gory detail), but stopped working, no social life. I would try anything, b/c nothing else has helped. Just got my labs and all those numbers stayed about the same except LDL jumped to 311. My doctore has called me in for a 'consult'. I'm having labs drawn, but in my case, I think the thyroid is an issue - those symptoms have gotton worse, Instead of more energy that everyone talks about with carnivore, I have less, I am cold , dec body temps (old school way of monitoring thyroid). ,and gaining weight (unwanted). I think these guys are dismissing the thyroid issue - b/c back in the old days, high chol was considered a sign of hypoT, and treated accordingly. I think that was scrubbed from education when pharma decided to push statins. Anyway, that' s my story. My plan/experiment is to supplement T3 - hopefully I will feel better and it will bring LDL down. I'd like to find a doc to help me .., but as we all know, it's hard. I might be using my mail order meds from another country and doing it on my own.. I just am unsure about the dose :)

[@connietrumpf2037]

Check out Dr. Bright.

[@johnfinnell4814]

If you’re having fullness under the ribs and difficulty digesting fats that means the drug is putting a burden functionally on your liver and gallbladder. Meaning it has a negative effect on your liver and gallbladder. Not sure how exactly it’s messing with the liver and gallbladder, but it clearly is. Any “side effect” from a drug is simply a sign that it is negatively affecting one, or multiple, organ systems.

[@scoobydadog246]

i'm kind of bummed that these guys are focusing on pharm interventions. The most obvious in my opinion would be to just do a little thyroid supplement, which is known to lower LDL. That's what i'm going to do . I hope they dig more into thyroid. they seem to blow off the low T3. If thyoid isn't optimal, nothing works well. Optimize that before throwing in poisons. That's my opinion :)

[@sanchezacostaagentedesegur4886]

I am a 62 year old man and 3 months ago I decided to got in keto. Yesterday i discover i got a LMHR in one month from 204 C T to 290 CT. I have passed headaches and some fogy cognitive. All my biomarkers very well. But i had got erectile disfunction since 2/3 weeks do you have suffered the same? This isssue is as important to me to think in quit keto and connect to a plant based diet like the dr Cadwhel Eseylinsys jr. When i switch to keto. I thougj that my hormones would work the better. Could you coment about?

[@Lionessliving]

Sounds like iodine deficiency. Subscribe to 5min body ( Carnivore lady who talks with functional medicine GP- on Iodine deficiency) over 90% of people are iodine deficient. Iodine is required to regulate hormones including testosterone! Lugols 5% 2-4 drops daily. Its an interesting video. Good luck 👍

[@duncangao9156]

I'm 1,000% sure that saturated fat has nothing to do with your LDL. I have few friends who's been doing OMAD for months but eat whatever they want (mostly carbs)...their TC and LDL go thru the roof, low trigs and high HDL just like LMHR. I guess OMAD for certain period of time would also put you into ketosis and that's what causes LDL to go up ...not saturated fat

[@ElizabethMillerTX]

Interesting. But my LDL shot up as soon as I increased (saturated) fat. (I was skinny-fat, meopausal.) I'm ever more convinced that saturated fat has little effect on LDL. Except maybe in a subset of us?

[@duncangao9156]

@@ElizabethMillerTX yes..Lean (BMI

[@scoobydadog246]

@@ElizabethMillerTX Hi Elizabeth! I'm just learning about this, b/c just got my labs and now doc calling me in to 'talk'. In my month my LDL went from 139 to 311, so total C is 432. TG 53 HDL 118 (basically stayed the same) A1C 5.4 BMI 17, menopausal also. Definitely not OMAD.. no gallbladder so ate often - 2-6x per day to spread fat out). As is common with LMHR's I have had hard time staying in ketosis, as much as I can with my testing, but i'm also not absorbing a lot of fat, as I have the toilet experience of the man in the video. I assume i'm using protein for gluconeogeneis. My energy has tanked. My theory (everyone has one, lol) is that it is the thyroid. My fool doc wouldn't test , but i"m doing on my own). In the old days, very high LDL was considered sign of hypothyroid. We know on keto/carnivore thyroid , esp T3 tends to go down. If ppl aren't symptomatic, that 's okay and I believe modern docs have forgotten a lot about the thyroid (b/c there are more profitable drugs to treat LDL). My hypothyroid symptoms have worsed - no energy, gaining weight, cold, low body temps (a great way to monitor thyroid). I believe the thyroid suppression could be contributing. Of course I can't rule out the fat. I did eat a lot of saturated fat before though. So it could be that , but I do know if the thyroid isn't optimal.. nothing works right. So ,how do you feel Elizabeth? I guess if you don't have symptomes, this might just be me, but i'm going to to try T3 supplement, I hope I can find a doc to help b/c I don't really know about dosage, and if I should also do T4. It does make me wonder though if T supplementation wouldn't be worth a try for all LMHRs! It is fairly benign - if you feel bad, just stop.. Theoretically, T3 should lower LDL

[@melissag3005]

Well.. I'm imparting a bit more of drama. I decided to go keto and I am on a aramotase inhibitor. I did have high TSH but t4 was fine, so the dr left it alone. my cholesterol did go up from a year prior, when I went on meds and off keto after the cancer diagnosis. So? All this to say.. I'm experimenting. I have zero desire to go on medication for it. My next appt is june where dr will also test fh and c-reactive. Dr knows my lack of desire to go on a statin...or anything, but the cancer drug may up my cholesterol. I did have a CT of my chest and it picked up "very mild" calcification and IDK how much this will add to her recommendation. My BMI 2 years ago was into the 35. I was on keto and my numbers were 188tot col, 62 trig, 76 hdl, 100 ldl. Now, off keto, my numbers at 24bmi on the medication: 205 tc, 76 trig, 72hdl, 118 ldl. NOW I am on keto looking forward to another round of tests...incredibly curious. I am also on clean keto. Moderate protein and it is all pastured meat and milk and dairy. 7-10 servings of keto veggies a day.

[@scoobydadog246]

Your LDL is LOW!! Why would your doc want you on a statin? That's insane. Look at all that is produced from cholesterol - hormones, CoQ10 for your mitochondria, and your cell menbranes your brain largely cholesterol. You even only have "mild" calcification! You need cholesterol to heal. Don't listen to me - I'm just a dog on TY :) , but these is so much research out there now. You have perfect labs!

[@melissag3005]

I'm not 100% sure but I think she wants to get ahead of anything in regard to the cancer drug which blocks my estrogen which causes my body to produce more cholesterol. Never ending feed back loop. My body wants more estrogen lol which they are blocking so my body sends a signal that it needs more estrogen so it needs to produce more cholesterol to make more estrogen. It's insane. This is the pharma play book. Never get sick....cause it's the pharma rabbit hole. Every drug has a side affect. There's a cascade effect to every drug. It's crazy. Can't even trust this drug to do its job. No idea if it's helping to stop anything. Never get sick! Prevention is key!

[@marcomakaveli8440]

LDL means nothing!!!!!

[@kathya1956]

Most going low carb are for weight loss or mostly diabetes.

[@iss8504]

Maybe. I am doing this for mental clarity.

[@nolanerunner1]

I did it to lower cholesterol Backfired big time Went from 5.8 to 9.1 Cardio will put me on statins despite angiogram being clear and calcium score of zero Trigs are good No diabetes

[@connietrumpf2037]

My father and both his parents and siblings had alzheimers. That's my why. I don't have diabetes nor am I obese

[@JMK-vo8pv]

When you gentlemen talk about "fat" in the diet, with respect to "Zetia"/ezetimibe Rx, please be clear on whether the word "fat" is referring to cholesterol or triglycerides or both. My understanding is that "fat" is TRIGLYCERIDES, not cholesterol. It is a real shame that the world of Medicine is so cavalier when it comes to medical terminology.

[@goratron1]

Cholesterol is essentially a subset in fat, fat is essentially the umbrella term.

[@jenjen789]

Dom seemed to be talking about dietary fat

[@barbarafairbanks4578]

@JMK-vo8pv They are both lipids (fats), but different types, and with different functions in the body.

[@mikeward9870]

Pathological capitalism and science do not mix.

[@margaritamartin9337]

Pick me! Follow me! I’ll be one of the thousand healthy population to participate in your work!

[@carmenross1077]

Dr. Nick Norwitz looked like that cartoon robot, no offense I almost left cause his face is the first I saw,until I saw the others. Nice discussion

[@jamesdellaneve9005]

He’s fit as all get out. He’s got the world record for pushups. Something like 438.

[@rolandrodriguez3854]

Is this Dr. Nick or.... G I Joe?

[@LakeOuachita]

😂😂😂 Dr NICK is ripped!